Comparison of Unplanned Extubations Associated with Orotracheal versus Nasotracheal Intubation in Neonates

Abstract Objective To evaluate the association between orotracheal versus nasotracheal intubation route and unplanned extubation (UE) risk among neonates. Study Design: This retrospective cohort study included all tracheal intubation (TI) events among neonates admitted to a level IV NICU from 2022 to 2024. Kaplan-Meier survival analysis was used to assess UE risk by TI route. Result There were 1,160 TI events and 23 UEs during the study period. The UE rate was three times lower in nasotracheal intubation group compared to orotracheal (0.01 vs 0.03 per 100 ventilator days). UE risk was significantly higher in orotracheally intubated infants (p = 0.03) with no differences when stratified by sex, gestational age, or birth weight. Conclusion Nasotracheal intubation was associated with lower UE risk in neonates in a unit that predominantly performs nasotracheal intubation. Prospective randomized studies are needed to further investigate if TI route may contribute to fewer UEs in this population.