EC Paediatrics

Background: Endotracheal intubation (ETT) plays a crucial role in managing airways during advanced neonatal resuscitation for premature infants with respiratory distress syndrome. Despite advancements in medical technology that offer less invasive airway management options during general anesthesia, these methods still face significant limitations when applied to many pre-term and full-term infants. The Neonatal Laryngeal Mask (NLM) is a new device designed for pre-term infants that previously demonstrated safety and efficacy while inducing surgical plane anesthesia and facilitating tracheal catheterization in piglets. In this study, we aimed to observe the efficacy of the NLM when applied to neonatal mannikins in comparison to ETT.

Methods: This study compared the efficacy of the NLM to ETT using neonatal manikins, and involved six groups of healthcare professionals: PGY-1 and PGY-2 pediatrics residents, PGY-3 pediatrics residents and neonatology fellows, Neonatal Nurse practitioners, third-year medical students, attending neonatologists, and private pediatricians. Participants were trained on both devices and performed three attempts each. Outcomes measured included time to lung inflation, number of attempts, and failure rates. Statistical analysis used t-tests with a significance level of p < 0.05.

Results: The NLM consistently outperformed ETT in securing the airway, with significantly faster average times across all healthcare professional groups (p < 0.001). Average times for airway placement using ETT ranged from 18.1 to 19.8 seconds, while NLM times ranged from 9.3 to 12.8 seconds. The mean time reduction with the NLM varied by group, from 6.2 seconds among PGY-1 and PGY-2 residents to 9.1 seconds among third-year medical students. All participants successfully completed airway placements with both methods following training, with no failed attempts recorded.

Conclusion: This study demonstrates that the NLM consistently provides faster airway securing compared to ETT across various healthcare professional groups. The NLM's efficiency could improve neonatal care by reducing delays in emergency situations, especially in resource-limited settings where ETT complications are more prevalent. While promising, further research is needed to evaluate proficiency, long-term outcomes, and training strategies for broader NLM adoption.

 Keywords: Neonatal Airway; Neonatal Laryngeal Mask; Anesthesia; Airway Management; Endotracheal Tube; Mannikin; Emergent Intubation; Advanced Airway

1. Alanazi A. “Intubations and airway management: An overview of Hassles through third millennium”. Journal of Emergencies, Trauma, and Shock 2 (2015): 99-107.
2. Reuter S., et al. “Respiratory distress in the newborn”. Pediatrics in Review 10 (2014): 417-429.
3. Glenn T., et al. “Patient characteristics associated with complications during neonatal intubations”. Pediatric Pulmonology 8 (2021): 2576-2582.
4. Brain AI. “The development of the Laryngeal Mask--a brief history of the invention, early clinical studies and experimental work from which the Laryngeal Mask evolved”. European Journal of Anaesthesiology Supplement 4 (1991): 5-17.
5. Wemyss-Holden SA., et al. “The laryngeal mask airway in experimental pig anaesthesia”. Laboratory Animals 1 (1999): 30-34.
6. Kazakos GM., et al. “Use of the laryngeal mask airway in rabbits: placement and efficacy”. Laboratory Animals 4 (2007): 29-34.
7. Wanous AA., et al. “Feasibility of laryngeal mask airway device placement in neonates”. Neonatology3 (2017): 222-227.
8. Park C., et al. “The laryngeal mask airway in infants and children”. Canadian Journal of Anesthesia 4 (2001): 413-417.
9. Ayoob Ali. “Innovative neonatal laryngeal mask for airway management in piglets: A new device for potential use in preterm and term neonates". Acta Scientific Paediatrics10 (2021): 03-08.
10. Foglia EE., et al. “Factors associated with adverse events during tracheal intubation in the NICU”. Neonatology1 (2015): 23-29.