title: Failed endotracheal intubation and adverse outcomes among extremely low birth weight infants.
abstract: OBJECTIVE
  To quantify the importance of successful endotracheal intubation on the first attempt among extremely low birth weight (ELBW) infants who require resuscitation after delivery.
  
  
  METHODS
  A retrospective chart review was conducted for all ELBW infants ⩽1000 g born between January 2007 and May 2014 at a level IV neonatal intensive care unit. Infants were included if intubation was attempted during the first 5 min of life or if intubation was attempted during the first 10 min of life with heart rate <100. The primary outcome was death or neurodevelopmental impairment. The association between successful intubation on the first attempt and the primary outcome was assessed using multivariable logistic regression with adjustment for birth weight, gestational age, gender and antenatal steroids.
  
  
  RESULTS
  The study sample included 88 ELBW infants. Forty percent were intubated on the first attempt and 60% required multiple intubation attempts. Death or neurodevelopmental impairment occurred in 29% of infants intubated on the first attempt, compared with 53% of infants that required multiple attempts, adjusted odds ratio 0.4 (95% confidence interval 0.1 to 1.0), P<0.05.
  
  
  CONCLUSIONS
  Successful intubation on the first attempt is associated with improved neurodevelopmental outcomes among ELBW infants. This study confirms the importance of rapid establishment of a stable airway in ELBW infants requiring resuscitation after birth and has implications for personnel selection and role assignment in the delivery room.
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Wallenstein
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Birnie
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Y H
authors.initials: YH
authors.lastname: Arain
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: W
authors.initials: W
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: N K
authors.initials: NK
authors.lastname: Yamada
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: L C
authors.initials: LC
authors.lastname: Huffman
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.|Department of Pediatrics, Division of Systems Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Palma
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: V Y
authors.initials: VY
authors.lastname: Chock
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: G M
authors.initials: GM
authors.lastname: Shaw
authors.affiliation: Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: D K
authors.initials: DK
authors.lastname: Stevenson
mesh_terms: D002140:California; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality; D005260:Female; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D020380:Needs Assessment; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D061665:Time-to-Treatment; D017211:Treatment Failure