292 - Impact of the Presence of an Attending Neonatologist on Neonatal Intubation Success and Adverse Events

Poster Number: 292
Publication Number: 292.3146

Background: Endotracheal intubation is an important procedure for critically ill newborns. Increased operator experience increases success and reduces adverse events. However, the impact of an attending neonatologist supervisor on first attempt intubation success and adverse outcomes is unknown.

Objective: To estimate the effect of attending neonatologist presence on 1) first attempt intubation success and 2) adverse tracheal intubation associated events.

Design/Methods: Retrospective review of neonatal intubations in 24 centers from the National Emergency Airway Registry for Neonates (NEAR4NEOs) from 1 October 2014 to 31 December 2022. All intubation encounters with complete data for attending neonatologist presence and adjustment variables were included. The primary outcome was successful first attempt intubation. Secondary outcomes were severe/non-severe tracheal intubation associated events, and severe oxygen desaturation.
Univariate associations between attending neonatologist presence and outcomes were estimated using logistic regression. Multivariable analyses were performed for primary/secondary outcomes to adjust for potential confounders (a minimally sufficient adjustment set using a directed acyclic graph [DAG], Fig. 1). Subgroup analyses were performed for operator experience and infant gestational age.

Results: Among 12,652 intubation encounters, an attending neonatologist was present for 8,391 (66%). Of all intubations, 6,724 (53%) were successful on the first attempt. Patient demographics are detailed in Table 1.
On univariate analysis, attending neonatologist presence was associated with higher odds of first attempt intubation success (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.04-1.2). However, on multivariate analysis including covariates identified in the DAG, attending presence was not associated with first attempt intubation success (aOR 1.05, 95% CI 0.97-1.13). In subgroup analyses, attending presence was associated with increased odds of first attempt success for inexperienced operators ( < 2 years’ experience) (aOR 1.27, 95% CI 1.11-1.46) and infants born >34 weeks’ gestation (aOR 1.18, 95% CI 1.02-1.37, Table 2).
Attending presence was associated with lower odds of dysrhythmia (aOR 0.84, 95% CI 0.73-0.97) and severe oxygen desaturation (aOR 0.88, 95% CI 0.81-0.96). This effect was more pronounced for inexperienced operators.

Conclusion(s): Overall, attending neonatologist presence was not associated with first attempt intubation success, however there was a positive effect for inexperienced operators. Severe desaturation and dysrhythmia were less common when an attending was present.