A Randomized Trial of Stylets for Intubating Newborn Infants

OBJECTIVE: Endotracheal intubation of newborn infants is a common and potentially lifesaving procedure but a skill that trainees find difficult. Despite widespread use, no data are available on whether the use of a stylet (introducer) improves success rates. We aimed to determine whether pediatric trainees were more successful at neonatal orotracheal intubation when a stylet was used. METHODS: An unblinded randomized controlled trial conducted between July 2006 and January 2009 at a tertiary perinatal center, the Royal Women’s Hospital, Melbourne, Australia. Eligible participants were newborn infants in the delivery room or NICU requiring endotracheal intubation for respiratory support. Infants were intubated by pediatric residents or fellows. Infants were randomized to have the procedure performed by using either an endotracheal tube alone or with a stylet. Successful intubation at the first attempt assessed by colorimetric detection of expired carbon dioxide was the primary outcome. RESULTS: Three hundred two intubations were performed in 232 infants (residents performed 75%, fellows 25%). Intubation was successful in 57% of the stylet group and 53% of the no stylet group (P = .47); odds ratio 1.18 (95% confidence interval 0.75–1.86). There were no differences in the duration of attempts or in the rate of upper airway trauma between the 2 groups. These results were consistent across subgroups of infants based on birth weight, gestational age, and site of intubation (delivery room or NICU). CONCLUSIONS: Using an endotracheal stylet did not significantly improve the success rate of pediatric trainees at neonatal orotracheal intubation. Pediatrics 2013;131:e198–e205 AUTHORS: C. Omar F. Kamlin, DMedSci,abc Liam A.F. O’Connell, MRCPI,a,d Colin J. Morley, MD,a,b,c Jennifer A. Dawson, PhD,abc Susan M. Donath, PhD,c Colm P.F. O’Donnell, PhD,d and Peter G. Davis, MDabc aNewborn Services, The Royal Women’s Hospital, Melbourne, Australia; bDepartments of Obstetrics and Gynecology, University of Melbourne, Australia; cClinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Melbourne, Australia; dCork University Maternity Hospital, Cork, Ireland; and eThe National Maternity Hospital, Dublin, Ireland