Nasotracheal Intubation in Extreme Prematurity and Traumatic Brain Injury: A Cautionary Tale

We report a case of a male neonate delivered urgently via cesarean at 27 weeks of gestation for placenta abruption who was apneic at birth and needed endotracheal intubation. Traumatic nasal intubation with injury to the cribriform plate and tract through the right cerebral hemisphere occurred. Now at 10 years of age, he has left hemiplegic cerebral palsy, autism spectrum disorder, intellectual disability, and externalizing disruptive behavior. This case highlights a potential complication of nasal intubation in preterm infants and the importance of considering this in choosing the route of intubation in preterm infants.