Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Survival and short-term respiratory outcomes of <750 g infants initially intubated with 2.0 mm vs. 2.5 mm endotracheal tubes

Journal of Perinatology volume 42, pages 202–208 (2022)Cite this article

Subjects

Abstract

Objectives

To compare survival and short-term respiratory outcomes of infants weighing <750 g initially intubated with 2.0 mm versus 2.5 mm endotracheal tube (ETT).

Study design

Retrospective, observational cohort study.

Results

Of 149 inborn infants weighing <750 g admitted to the NICU, 69 (46%) were intubated with 2.0 mm ETT, 78 with 2.5 mm ETT (53%), and 2 infants never required intubation. Infants intubated with 2.0 mm ETT were more premature (median gestational age (GA) 23 weeks (22, 24) vs. 24 weeks (24, 25) p < 0.0001), smaller (median birth weight 545 g (450, 616) vs. 648 g (579, 700), p < 0.0001), and more frequently intubated at delivery (96% vs. 68%, p < 0.00001). Survival to discharge was similar 77%, 53/69 and 87%, 68/78 (p = 0.09). Adjusted for GA, there were no significant differences in ventilator days (p = 0.7338) or Grade 3 BPD.

Conclusions

Premature infants born at a median GA of 23 weeks and median birth weight of 545 g can be successfully managed with 2.0 mm ETT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Ecker JL, Kaimal A, Mercer BM, Blackwell SC, deRegnier RAO, Farrell RM, et al. Periviable birth: interim update. Am J Obstet Gynecol. 2016;215:B2–B12.e1.

  2. Lau C, Ambalavanan N, Chakraborty H, Wingate MS, Carlo WA. Extremely low birth weight and infant mortality rates in the United States. Pediatrics. 2013;131:855–60.

    Article  Google Scholar 

  3. Stoll BJ, Hansen NI, Bell EF, Walsh MC, Carlo WA, Shankaran S, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA. 2015;314:1039–51.

    Article  CAS  Google Scholar 

  4. Younge N, Goldstein RF, Bann CM, Hintz SR, Patel RM, Smith PB, et al. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med. 2017;376:617–28.

    Article  Google Scholar 

  5. Fayoux P, Devisme L, Merrot O, Marciniak B. Determination of endotracheal tube size in a perinatal population: an anatomical and experimental study. Anesthesiology. 2006;104:954–60.

    Article  Google Scholar 

  6. Bader D, Kugelman A, Boyko V, Levitzki O, Lerner-Geva L, Riskin A, et al. Risk factors and estimation tool for death among extremely premature infants: a national study. Pediatrics. 2010;125:696–703.

    Article  Google Scholar 

  7. Litmanovitz I, Reichman B, Arnon S, Boyko V, Lerner-Geva L, Bauer-Rusak S, et al. Perinatal factors associated with active intensive treatment at the border of viability: a population-based study. J Perinatol. 2015;35:705–11.

    Article  CAS  Google Scholar 

  8. Tyson JE, Younes N, Verter J, Wright LL. Viability, morbidity, and resource use among newborns of 501- to 800-g birth weight. National Institute of Child Health and Human Development Neonatal Research Network. JAMA. 1996;276:1645–51.

    Article  CAS  Google Scholar 

  9. Laing IA, Cowan DL, Ballantine GM, Hume R. Prevention of subglottic stenosis in neonatal ventilation. Int J Pediatr Otorhinolaryngol. 1986;11:61–6.

    Article  CAS  Google Scholar 

  10. In: Weiner GM, Zaichkin J, editors. American Academy of Pediatrics and American Heart Association. Textbook of Neonatal Resuscitation (NRP), 7th edn. American Academy of Pediatrics; 2016:326 p.

  11. Jensen EA, Dysart K, Gantz MG, McDonald S, Bamat NA, Keszler M, et al. The diagnosis of bronchopulmonary dysplasia in very preterm infants. an evidence-based approach. Am J Respir Crit Care Med. 2019;200:751–9.

    Article  CAS  Google Scholar 

  12. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443–56.

    Article  Google Scholar 

  13. Kyser KL, Morriss FH Jr., Bell EF, Klein JM, Dagle JM. Improving survival of extremely preterm infants born between 22 and 25 weeks of gestation. Obstet Gynecol. 2012;119:795–800.

    Article  Google Scholar 

  14. Travers CP, Carlo WA, McDonald SA, Das A, Bell EF, Ambalavanan N, et al. Mortality and pulmonary outcomes of extremely preterm infants exposed to antenatal corticosteroids. Am J Obstet Gynecol. 2018;218:130.e1–e13.

    Article  Google Scholar 

  15. Mori R, Kusuda S, Fujimura M. Antenatal corticosteroids promote survival of extremely preterm infants born at 22 to 23 weeks of gestation. J Pediatr. 2011;159:110–4. e1

    Article  CAS  Google Scholar 

  16. Ehret DEY, Edwards EM, Greenberg LT, Bernstein IM, Buzas JS, Soll RF, et al. Association of antenatal steroid exposure with survival among infants receiving postnatal life support at 22 to 25 weeks’ gestation. JAMA Netw Open. 2018;1:e183235.

    Article  Google Scholar 

  17. Brown MS. Prevention of accidental extubation in newborns. Am J Dis Child. 1988;142:1240–3.

    CAS  PubMed  Google Scholar 

  18. Silva PS, Reis ME, Aguiar VE, Fonseca MC. Unplanned extubation in the neonatal ICU: a systematic review, critical appraisal, and evidence-based recommendations. Respir Care. 2013;58:1237–45.

    Article  Google Scholar 

  19. Veldman A, Trautschold T, Weiss K, Fischer D, Bauer K. Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatr Anaesth. 2006;16:968–73.

    Article  Google Scholar 

  20. Fanaroff AA, Stoll BJ, Wright LL, Carlo WA, Ehrenkranz RA, Stark AR, et al. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007;196:147.e1–8.

    Article  Google Scholar 

  21. Hakansson S, Farooqi A, Holmgren PA, Serenius F, Hogberg U. Proactive management promotes outcome in extremely preterm infants: a population-based comparison of two perinatal management strategies. Pediatrics. 2004;114:58–64.

    Article  Google Scholar 

  22. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372:1801–11.

    Article  Google Scholar 

  23. Smith PB, Ambalavanan N, Li L, Cotten CM, Laughon M, Walsh MC, et al. Approach to infants born at 22 to 24 weeks’ gestation: relationship to outcomes of more-mature infants. Pediatrics. 2012;129:e1508–16.

    Article  Google Scholar 

  24. Watkins PL, Dagle JM, Bell EF, Colaizy TT. Outcomes at 18 to 22 months of corrected age for infants born at 22 to 25 weeks of gestation in a center practicing active management. J Pediatr. 2020;217:52–8.

    Article  Google Scholar 

Download references

Funding

This work was supported by the University of Iowa. No funding for this research was received.

Author information

Authors and Affiliations

  1. Children’s Minnesota, Neonatal Medicine, Minneapolis, MN, USA

    Jennifer N. Berger

  2. University of Iowa, Stead Family Department of Pediatrics, Iowa City, IA, USA

    Timothy G. Elgin, John M. Dagle, Jonathan M. Klein & Tarah T. Colaizy

Authors
  1. Jennifer N. Berger
    View author publications

    Search author on:PubMed Google Scholar

  2. Timothy G. Elgin
    View author publications

    Search author on:PubMed Google Scholar

  3. John M. Dagle
    View author publications

    Search author on:PubMed Google Scholar

  4. Jonathan M. Klein
    View author publications

    Search author on:PubMed Google Scholar

  5. Tarah T. Colaizy
    View author publications

    Search author on:PubMed Google Scholar

Contributions

All authors participated in the design, editing, and writing of the study. All authors approved the final manuscript. JNB, JMD, and TTC designed the study. JNB extracted the data, interpreted the results, and wrote the manuscript. TGE extracted the data and edited the manuscript. JMD and JMK assisted with content and revision. TTC conducted the statistical analysis of the data, interpreted the results, and created the figures.

Corresponding author

Correspondence to Jennifer N. Berger.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berger, J.N., Elgin, T.G., Dagle, J.M. et al. Survival and short-term respiratory outcomes of <750 g infants initially intubated with 2.0 mm vs. 2.5 mm endotracheal tubes. J Perinatol 42, 202–208 (2022). https://doi.org/10.1038/s41372-021-01227-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-021-01227-y

This article is cited by

Search

Advanced search

Quick links