title: Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open-label, three-armed randomized controlled trial.
abstract: OBJECTIVE
  To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip.
  
  
  METHODS
  Open-label, randomized controlled trial (RCT).
  
  
  METHODS
  Level III neonatal intensive care unit (NICU).
  
  
  METHODS
  All newborn babies admitted in NICU requiring intubation.
  
  
  METHODS
  Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained.
  
  
  METHODS
  Rate of malposition of ETT as judged on chest X-ray (CXR).
  
  
  RESULTS
  Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique.
  
  
  CONCLUSIONS
  Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates.
authors.affiliation: Neonatal Unit, Department of Pediatrics, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Ashwin R
authors.initials: AR
authors.lastname: Saboo
authors.forename: Sourabh
authors.initials: S
authors.lastname: Dutta
authors.forename: Kushaljit Singh
authors.initials: KS
authors.lastname: Sodhi
mesh_terms: D001724:Birth Weight; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D015588:Observer Variation; D010173:Palpation / Q000379:methods*; D013902:Radiography, Thoracic; D018401:Sample Size; D016896:Treatment Outcome
keywords: endotracheal; infant; intubation; newborn; resuscitation