Cuffed Endotracheal Tubes in Neonates

Background: Cuffed endotracheal tubes (ETT) are becoming increasingly used in neonates; nevertheless, current data in the literature mostly include infants of over 3000 grams in weight. Objectives: The aim of this study was to compare the use of cuffed and uncuffed ETT in neonates in the neonatal intensive care unit (NICU) of a tertiary children’s hospital, assessing the presence of airway complications. Methods: We performed a single-center retrospective cohort study. Our study included all term neonates receiving cuffed ETT over the period from January 2019 to December 2021. The controls were all neonates receiving an uncuffed ETT over the same period. Results: Twenty-five patients were intubated with cuffed ETT in the study period. The group receiving cuffed ETT was compared with 53 patients with uncuffed ETT. All cuffed ETT were inserted in the operating room by anesthesiologists. Comparing the outcomes of the cuffed ETT group with controls, there were no significant differences in the number of unplanned extubations, reintubation episodes, ventilator-associated pneumonia, episodes of atelectasis, the use of dexamethasone or vocal cord paresis. No unplanned extubation was observed in the cuffed ETT group and no cases of subglottic stenosis were observed in either of the groups. Conclusion: This retrospective study with a small sample size suggests that the use of cuffed ETT in surgical patients > 2000 g in weight is not associated with an increase in airway complications. Well-designed randomized controlled trials are needed to compare cuffed ETT with uncuffed ETT.