Impact of attending neonatologist presence on neonatal intubation success and adverse events: a cohort study

Abstract Objective To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events. Study design Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014 - December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes. Results Among 12,652 intubation encounters, attendings were present for 8,391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with first attempt intubation success (OR 1.11, 95% CI 1.04–1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70–0.86) and intubation requiring ≥ 3 intubation attempts (aOR 1.39, 95% CI 1.21–1.60). Conclusion After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.