Neonatal Intubation: Success of Pediatric Trainees

Pediatric trainees now are required by the Residency Review Committee of the Accreditation Council for Graduate Medical Education to be competent in neonatal endotracheal intubation. The investigators reviewed all neonatal intubations attempted during nearly 11 years at a level III neonatal intensive care unit admitting approximately 600 patients annually. Currently, residents are required to spend at least 4 months, and no more than 6 months, in intensive care training that includes neonatal and pediatric intensive care. An attempt was defined as placing a laryngoscope in the infant's mouth. Success is an attempt leading to successful tube placement in the infant's trachea, as evidenced by auscultation of breath sounds, chest expansion, and clinical improvement. A colorimetric CO2 detector recently was introduced to confirm successful intubation. A total of 5051 successful intubations out of 9190 attempts by all practitioners were recorded during the period under review. Pediatric residents made 3719 attempts and succeeded in 1676 of them. The median success rate was 33% for pediatric level (PL)1 residents, 40% for PL2 and PL3 residents, and 68% for neonatal fellows. Residents making more than 20 total attempts succeeded 49% of the time, compared with 37% for those making fewer attempts. For pediatric residents, comparable success rates approximating 36% were achieved for nonmeconium intubations attempted in the delivery room and in the neonatal intensive care unit. The mean number of intubation attempts made by residents throughout their training decreased from 38 in 1994 to 12 in 2002 (Fig. 1). Overall success rates declined significantly throughout training for each graduating class of residents, from 60% in year 1 to 32% in year 9.Fig. 1: Mean number of intubation attempts (black bars) and mean number of successful intubations (white bars) by pediatric trainees during their residency program are plotted against the year of training completion (with standard deviations).Reprinted from the Journal of Pediatrics, vol 146, Leone, et al., Neonatal Intubation: Success of Pediatric Trainees, Pages 638-641, Copyright ©2005, with permission from Elsevier.The investigators conclude that, at present, pediatric trainees are not adequately prepared to intubate newborn infants.