Rapid estimation of insertional length of endotracheal intubation in newborn infants,☆☆,

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Abstract

Objective: To create a simple and accurate method of predicting the correct insertional length of endotracheal intubation during resuscitation of neonates.

Study Design: Phase I of the study enrolled infants that required either orotracheal or nasotracheal intubations. The endotracheal tube position was confirmed by auscultation and radiographic images. Three regression equations were then created using nasal-tragus length, sternal length, and birth weight on insertional length. In phase II of the study, the modified regression equations of nasotracheal and sternal length were used to predict endotracheal tube insertional length in 50 infants (40 orotracheal and 10 nasotracheal).

Results: Nasal-tragus length and sternal length are good parameters to estimate insertional length for endotracheal intubation ( p < 0.005 for both the parameters). The modified prediction equation for insertional length of the endotracheal tube for the orotracheal route is NTL or STL + 1. For the nasotracheal route the equation is NTL or STL + 2.

Conclusion: During resuscitation of the neonate when vital parameters are difficult to obtain, the insertional length of endotracheal intubation can be quickly and accurately predicted by nasal-tragus length or sternal length. (J Pediatr 1997;131:561-4)

Section snippets

Methods

The study population included sick newborn infants born at New York University Medical Center, Bellevue Hospital, and Flushing Hospital Medical Center that required intubation. During phase I of the study, 66 infants were intubated by the oral route and 18 infants were intubated by the nasal route. The ET tubes used in the study were calibrated at each centimeter distance (Concord/Portex, Keene, N.H.). The following parameters were measured on each patient: (1) nasal-tragus length, defined as

Results

During phase I of the study, 66 infants required orotracheal intubation: 35 females and 31 males with a gestational age of 31.1 ± 4.7 weeks (mean ± 1 SD), with a range of 23 to 42 weeks. Their BWs were 1610 ± 840 gm (mean ± 1 SD), with a range of 550 to 4500 gm. In the nasotracheal group there were 18 infants (10 females and 8 males) with gestational ages of 32.4 ± 4.1 weeks (mean ± 1 SD) and a range of 28 to 40 weeks. Their weights were 1870 ± 1100 gm (mean ± 1 SD), with a range of 837 to 3900

Discussion and Conclusion

This study demonstrates that NTL and STL can be used swiftly and accurately to calculate ET tube insertional length for neonates using the mnemonics. Both the actual and the modified equations can be used to predict ET insertional lengths. NTL and STL are easily and correctly calculated either by measurement tape or by placing the ET tube directly on the respective body part (NTL or STL). Adding 1 or 2 cm to this measurement gives the respective ET tube insertional length for either orotracheal

Acknowledgements

We sincerely thank Mrugank Shukla of Cardozo High School, Bayside, for his typing and art work.

References (6)

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From the New York University Medical Center, New York, and New York Flushing Hospital, Queens.

☆☆

Reprint requests: H. Shukla, MD, Children’s Medical Center, 42-72, Kissena Boulevard, Flushing, NY 11355.

9/21/80528

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