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Children
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Neonatal Airway Management
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Neonatal Airway Management

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neonatology".

Deadline for manuscript submissions: closed (25 April 2023) | Viewed by 19468

Special Issue Editor

Dr. Joaquim M. B. Pinheiro

E-Mail Website
Guest Editor
Department of Pediatrics, Albany Medical College, MC-101, 47 New Scotland Avenue, Albany, NY 12208, USA
Interests: quality and safety in neonatal airway management; focusing on intubation and unplanned extubation; newborn resuscitation; neonatal epidemiology

Special Issue Information

Dear Colleagues,

Neonates needing assisted ventilation often require an artificial airway. The normal neonatal airway is intrinsically difficult to manage due to its small dimensions and anatomical relationships, which also vary widely between extremely preterm and full-term newborns. Neonates are often physiologically unstable, and some have airway anomalies. Airway-management devices are typically designed for use in adults and are subsequently downsized for newborns. Consequently, tracheal intubation of neonates has a relatively low success rate, and it is associated with acute risks and long-term complications. Additionally, unplanned extubations occur more frequently in newborns than any other age group. These problems are currently addressed by single-center and collaborative efforts, using clinical research, quality improvement and patient safety methodologies. Finally, devices are being increasingly developed to support less-invasive respiratory support of neonates, and to facilitate airway management with reduced technical expertise required of neonatal caregivers.

This Special Issue of Children will address current topics in neonatal airway management, including normal and anomalous development and injury, tracheal intubation and its associated complications, as well as devices and techniques used in airway instrumentation. Original research, quality improvement reports, or review papers will be considered for publication. We look forward to receiving your individual or collaborative contributions on these topics.

Dr. Joaquim M. B. Pinheiro
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Neonatal airway development
  • Neonatal intubation
  • Difficult airways in newborns
  • Intubation safety
  • Endotracheal tubes
  • Laryngeal mask/supraglottic airway devices
  • Adverse events in neonatal ventilation
  • Unplanned extubation

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Published Papers (4 papers)

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Research

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14 pages, 2525 KiB  
Article
A Survey of the Union of European Neonatal and Perinatal Societies on Neonatal Respiratory Care in Neonatal Intensive Care Units
by Corrado Moretti, Camilla Gizzi, Luigi Gagliardi, Flavia Petrillo, Maria Luisa Ventura, Daniele Trevisanuto, Gianluca Lista, Raffaele L. Dellacà, Artur Beke, Giuseppe Buonocore, Antonia Charitou, Manuela Cucerea, Boris Filipović-Grčić, Nelly Georgieva Jeckova, Esin Koç, Joana Saldanha, Manuel Sanchez-Luna, Dalia Stoniene, Heili Varendi, Giulia Vertecchi and Fabio Moscaadd Show full author list remove Hide full author list
Children 2024, 11(2), 158; https://doi.org/10.3390/children11020158 - 26 Jan 2024
Cited by 5 | Viewed by 2371
Abstract
(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units [...] Read more.
(1) Background: Our survey aimed to gather information on respiratory care in Neonatal Intensive Care Units (NICUs) in the European and Mediterranean region. (2) Methods: Cross-sectional electronic survey. An 89-item questionnaire focusing on the current modes, devices, and strategies employed in neonatal units in the domain of respiratory care was sent to directors/heads of 528 NICUs. The adherence to the “European consensus guidelines on the management of respiratory distress syndrome” was assessed for comparison. (3) Results: The response rate was 75% (397/528 units). In most Delivery Rooms (DRs), full resuscitation is given from 22 to 23 weeks gestational age. A T-piece device with facial masks or short binasal prongs are commonly used for respiratory stabilization. Initial FiO2 is set as per guidelines. Most units use heated humidified gases to prevent heat loss. SpO2 and ECG monitoring are largely performed. Surfactant in the DR is preferentially given through Intubation-Surfactant-Extubation (INSURE) or Less-Invasive-Surfactant-Administration (LISA) techniques. DR caffeine is widespread. In the NICUs, most of the non-invasive modes used are nasal CPAP and nasal intermittent positive-pressure ventilation. Volume-targeted, synchronized intermittent positive-pressure ventilation is the preferred invasive mode to treat acute respiratory distress. Pulmonary recruitment maneuvers are common approaches. During NICU stay, surfactant administration is primarily guided by FiO2 and SpO2/FiO2 ratio, and it is mostly performed through LISA or INSURE. Steroids are used to facilitate extubation and prevent bronchopulmonary dysplasia. (4) Conclusions: Overall, clinical practices are in line with the 2022 European Guidelines, but there are some divergences. These data will allow stakeholders to make comparisons and to identify opportunities for improvement. Full article
(This article belongs to the Special Issue Neonatal Airway Management)
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9 pages, 1258 KiB  
Article
Tracheal Length Measurement in Intubated Neonates to Guide the Design and Use of Endotracheal Tube Glottic Depth Markings
by Jennifer B. Cerone and Joaquim M. B. Pinheiro
Children 2022, 9(2), 169; https://doi.org/10.3390/children9020169 - 29 Jan 2022
Cited by 5 | Viewed by 7814
Abstract
Background: Data on neonatal tracheal length are needed to inform the standardization of safety features for endotracheal tubes (ETTs) such as glottic depth markings. Laryngotracheal airway measurements are available from digital imaging in infants and children but not in neonates. We aimed to [...] Read more.
Background: Data on neonatal tracheal length are needed to inform the standardization of safety features for endotracheal tubes (ETTs) such as glottic depth markings. Laryngotracheal airway measurements are available from digital imaging in infants and children but not in neonates. We aimed to determine the tracheal length (TL) of intubated preterm and term neonates. Methods: An observational study was performed on 57 neonates of 22–42 weeks’ gestation and <1 week of age. Two clinicians independently reviewed 153 digital chest radiographs to determine the carina position and TL. TL was measured from carina to mid-C4 (cricoid level). We analyzed interrater agreement (within 0.5 vertebral levels) on the position of the carina and TL. TL was plotted as a function of gestational age and weight, using graphical and regression analyses. Results: Carina position ranged from T3 to T5.5, with an interrater agreement of 95%. On image pairs concordant for carina position, TL determinations were virtually identical between readers (mean difference 0.1 mm, 95% CI −0.5–0.6 mm). Average mid-tracheal length overlies the body of T1. In infants aged less than 32 weeks’ gestation, the mid-trachea lies <20 mm from the carina or the larynx. TL linearly correlates with gestational age, but correlation with birthweight best fits a segmented regression with a node at 1 kg. Conclusions: The functional length of the laryngotracheal airway can be reliably measured in sick neonates. It correlates well with gestational age and birthweight, and this information can inform the redesign of ETT markings to promote the safer use of these devices. Full article
(This article belongs to the Special Issue Neonatal Airway Management)
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Review

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17 pages, 4613 KiB  
Review
Neonatal Airway Abnormalities
by Adithya Srikanthan, Samantha Scott, Vilok Desai and Lara Reichert
Children 2022, 9(7), 944; https://doi.org/10.3390/children9070944 - 24 Jun 2022
Cited by 3 | Viewed by 3602
Abstract
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a [...] Read more.
Neonatal airway abnormalities are commonly encountered by the neonatologist, general pediatrician, maternal fetal medicine specialist, and otolaryngologist. This review article discusses common and rare anomalies that may be encountered, along with discussion of embryology, workup, and treatment. This article aims to provide a broad overview of neonatal airway anomalies to arm those caring for these children with a broad differential diagnosis and basic knowledge of how to manage basic and complex presentations. Full article
(This article belongs to the Special Issue Neonatal Airway Management)
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Other

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10 pages, 1248 KiB  
Project Report
Implementation of Surfactant Administration through Laryngeal or Supraglottic Airways (SALSA): A Jordanian NICU’s Journey to Improve Surfactant Administration
by Naser Aldain A. Abu Leyah, Abeer A. Hasan, John N. Juneau, Maryam Ali Al Jammal, Ghada A. Jaber, Gregory E. Wilding, Kari D. Roberts and Scott O. Guthrie
Children 2022, 9(8), 1147; https://doi.org/10.3390/children9081147 - 30 Jul 2022
Cited by 1 | Viewed by 4170
Abstract
Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. Surfactant administration through laryngeal or supraglottic airways (SALSA) is a simplified procedure for delivery of surfactant that is less invasive [...] Read more.
Administration of liquid surfactant through an endotracheal tube for the treatment of respiratory distress syndrome has been the standard of care for decades. Surfactant administration through laryngeal or supraglottic airways (SALSA) is a simplified procedure for delivery of surfactant that is less invasive and better tolerated. The Al Bashir Maternity and Children’s Hospital NICU in Amman, Jordan, implemented SALSA as a potentially better practice in 2019 with the objective to effectively and efficiently deliver surfactant in a minimally invasive way and to decrease the adverse events associated with intubation–surfactant–extubation (InSurE) and laryngoscopy. The quality improvement initiative was conducted from March 2019 to December 2019. All infants who weighed 750 g or more who required surfactant were eligible. As physicians were trained in the technique and use expanded, we were able to use plan–do–study–act cycles to observe differences between SALSA and InSurE. The primary aim was the optimization of non-invasive ventilation by the effective and efficient delivery of surfactant. Balancing measures included episodes of bradycardia while receiving surfactant or the need for a second dose of surfactant. We evaluated 220 infants who received surfactant by SALSA or InSurE with a mean gestational age of 32 weeks and a mean birth weight of 1.8 kg. The Respiratory Severity Score (RSS) prior to surfactant administration was 2.7 in the SALSA group compared to 2.9 in the InSurE group (p = 0.024). Those in the InSurE group had a lower mean heart rate during the procedure (p =< 0.0001) and were more likely to need a second dose of surfactant (p = 0.026) or require intubation for mechanical ventilation (p = 0.022). Both groups were effectively delivered surfactant as evidenced by improvement in their RSS over an 8 h period. SALSA was a more time efficient surfactant delivery method (93 vs. 111 secs, p =< 0.0001). Implementation of SALSA into the Al Bashir NICU was successful. We found that it was equally effective to InSurE, but was a more efficient method of delivery. Infants who received surfactant by this method tolerated it well. Full article
(This article belongs to the Special Issue Neonatal Airway Management)
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