Common Complications of Endotracheal Intubation in Newborns

Objective The purpose of this study was to assess the frequency of complications of endotracheal intubation (ETI) in neonates. Methods The newborns that were admitted and needed urgent or semi-urgent intubation were enrolled in this study over a 1 year period. Route for intubation in all cases were orotracheal. Cases were not routinely sedated or paralyzed. The patients were clinically and radiographically assessed. Results Of 233 newborn infants who were admitted to the neonatal intensive care unit (NICU) at the Children’s Medical Center, 60 infants were intubated. A total of 131 attempts were documented. Unsuccessful attempts with difficult intubation were 17(13%); successful intubation attempts were 114(87%). Complications were detected in 69 cases (61%). The most common complication was laryngeal injury (24%). Accidental extubation was the most frequent event (12%).Tube blockage 7% and endotracheal tube (ETT) malposition was 3%. The complications were less during placement of ETT (12%), but were high during maintenance (61%) and removal of the endotracheal tube (28%). 47% of patients required repeated intubation. There was a significant statistical difference between complications of medicated and unmedicated patients. There was no significant statistical difference relative to gestational age, route of delivery, sex, birth weight, and length of time the ETT remained in place.  Conclusion Trauma to the larynx and vocal cords were the most common complications. Difficult and repeated intubation played a major role. Premedication for non-urgent or semi-urgent intubation was safer and more effective than awake intubation. We did not assess long-term outcomes associated with endotracheal tube intubation; this was a limitation of the present study. Operator skill and postoperative care are confounding variables that may influence the results.