Association of Birth Weight with Delivery Room Endotracheal Intubation Success in Newborn Infants

Objective To examine the association between birth weight and first-attempt intubation success in the delivery room after adjusting for key practice characteristics. Study design This retrospective cohort study used data from the National Emergency Airway Registry for Neonates, including intubation encounters in the delivery room, from October 2014 to June 2022. The primary outcome was first-attempt success rate by birth weight. A logistic regression was created with birth weight as a continuous variable included in the model via restricted cubic splines to incorporate nonlinear effects. Additional outcomes included first-attempt success rate grouped by birth weight in 500 g intervals, number of attempts, and adverse events. Covariates included intubation method, device, provider experience, and discipline. Results A total of 3294 delivery room intubation encounters were collected. After exclusion of encounters with inconsistent reporting of intubation attempts, 3227 tracheal intubation encounters from 16 centers were included with a median gestational age of 30 weeks (IQR, 25-37). Fifty-one percent of all intubations were successful on first attempt. Birth weight had a significant, nonlinear effect on intubation success ( P < .001). Furthermore, birth weight had a significant, linear effect on the odds of adverse tracheal intubation-associated events ( P < .001). Conclusions Lower birth weight was associated with lower first-attempt intubation success and higher odds of adverse events during delivery room intubation. Awareness that smaller infants are at a higher risk for difficult intubation may help optimize provider selection, equipment preparation, and procedural planning in the delivery room.