241 - The association between Laryngoscopic attempts and Risk for Severe Intraventricular Hemorrhage in Preterm Infants born at < 29 weeks—A Retrospective Cohort Study

Poster Number: 241
Publication Number: 241.2858

Background: Endotracheal intubation has been associated with increased incidence of severe intraventricular hemorrhage (IVH) in preterm infants. However, the findings come from small studies with no differentiation whether less invasive administration (LISA) also carries same risk or not.

Objective: To assess association between numbers of laryngoscopic attempts, including LISA method, within the first 3 days after birth and severe IVH in extremely preterm neonates.

Design/Methods: This was a retrospective cohort study of infants born at 22-28 weeks’ gestation (GA) admitted to a tertiary NICU between July 2015 and December 2020. Infants were categorized into three groups: those with no exposure to laryngoscopic attempts, those with a single laryngoscopic attempt, and those with multiple laryngoscopic attempts. Subgroup analyses of those who had LISA was conducted. Univariate and multivariate analysis to assess the association between laryngoscopic attempts and risk for severe IVH. Adjusted odds of association were calculated after controlling for GA, sex, antenatal steroid, and mode of birth.

Results: Of the total 923 infants included, 162 (18%) had no laryngoscopic attempts, 451 (49%) had one (135 had LISA), and 310 (33%) had multiple laryngoscopic attempts (86 had LISA). Baseline characteristics for these three groups are summarized in Table 1. Univariate analysis showed significant increase in incidence of severe IVH in infants who were exposed to either single or multiple laryngoscopic attempts compared to those with no laryngoscopic attempts (p < 0.001). In contrast, no significant difference in severe IVH was seen between those who were exposed to a single versus multiple laryngoscopic attempts (p > 0.05, Table 2). LISA use had shown similar univariable association (Table 2). Multivariable regression analysis controlling for GA, antenatal steroid, sex, and mode of birth, revealed no association between intubation or LISA attempt and severe IVH (Table 3).

Conclusion(s): In this large cohort, the number of laryngoscopic attempts (for endotracheal intubation or LISA) within the first three days after birth was not associated with severe IVH.