Establishing and maintaining correct endotracheal tube (ETT) position is crucial to mechanical ventilation of the critically ill neonate. Although a significant number of low birthweight infants require endotracheal intubation, there have been few studies that have examined the effects of neck movement on ETT position in this population. The objective of this postmortem study was to determine the effects of neck flexion and extension on endotracheal tube (ETT) position in low birthweight infants. Method: Eight low birthweight orotracheally-intubated infants underwent three sets of anteroposterior chest radiographs with the neck in the following positions: neutral, flexed(55°) and extended (55°). Radiographic measurements from the thoracic inlet to the ETT tip were obtained in each position. Results: The ETT tip always moved caudad with neck flexion (p<0.001) and rostrally with neck extension (p<0.001). The magnitude of ETT displacement was 3.1mm (+/- 1.7mm) and 7.4mm (+/- 5.2mm) with neck flexion and extension, respectively(p<0.05). Conclusions: 1. The direction of ETT movement in low birthweight infants with neck flexion and extension is predictable and identical to that seen in term infants and children. 2. Neck extension(55°) results in more than twice the magnitude of ETT displacement than flexion (55°).
