Impact of attending neonatologist presence on neonatal intubation success and adverse events: a cohort study

Objective: To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events. Study design: Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014–December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes. Results: Among 12,652 intubation encounters, attendings were present for 8391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with higher first attempt intubation success (OR 1.11, 95% CI 1.04–1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70–0.86) and intubation requiring ≥3 intubation attempts (aOR 1.39, 95% CI 1.21–1.60). Conclusion: After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.