Nasal versus oral intubation in the neonatal intensive care unit: associations with procedural success and safety in a retrospective cohort study from the National Emergency Airway Registry for Neonates (NEAR4NEOS)

Objective To evaluate the frequency and safety of nasal versus oral endotracheal intubation procedures in infants admitted to a neonatal intensive care unit (NICU). Design Retrospective cohort study. Setting 29 centres across seven countries from April 2017 to March 2025. Patients Infants <1 year of age undergoing endotracheal intubation. Main outcome measures Primary outcome was first course success, with course defined as all intubation attempts without a change in equipment, premedication or route. Secondary outcomes were first attempt success, adverse tracheal intubation-associated events (TIAEs), severe TIAEs and severe desaturations. Adjusted relative risks (aRR) were estimated using Poisson regression accounting for centre, patient, provider and procedural variables. Results Among 20 350 intubation courses (nasal 1057 (5.2%); oral 19 293 (94.8%)), nasal intubations occurred at 17 of 29 centres, with site-level use ranging from 0% to 99.2%. In fully adjusted models, nasal compared with oral intubation was associated with decreased course success (aRR 0.89; 95% CI 0.84 to 0.94, p<0.001), first attempt success and increased risk for severe desaturation. There were no significant differences in TIAEs. In a post-hoc analysis, these associations were not present at sites where intubations were predominantly performed via nasal route. Conclusions Nasal intubation may not be the preferred approach for infants in settings where it is infrequently performed but may achieve comparable or improved intubation-related outcomes in centres with established expertise.

Authors

Institutions

Publication Details

Journal
Archives of Disease in Childhood Fetal & Neonatal
Published
2026-09-30
DOI
https://doi.org/10.1136/archdischild-2026-331137
Primary Topic
Neonatal Respiratory Health Research
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

Nasal versus oral intubation in the neonatal intensive care unit: associations with procedural success and safety in a retrospective cohort study from the National Emergency Airway Registry for Neonates (NEAR4NEOS)

Michael R Narvey, David M. Rub, Rebecca Shay, Kate Alison Hodgson et al.
Archives of Disease in Childhood Fetal & Neonatal
Neonatal Respiratory Health Research
article

Nasal versus oral intubation in the neonatal intensive care unit: associations with procedural success and safety in a retrospective cohort study from the National Emergency Airway Registry for Neonates (NEAR4NEOS)

Michael R Narvey, David M. Rub, Rebecca Shay, Kate Alison Hodgson, Dinushan C. Kaluarachchi, Ayman Abou Mehrem, Cassandra DeMartino, Natalie Napolitano, Katharina Bibl, Heidi M. Herrick, Stephen D. DeMeo, Erik A. Jensen, Sara B. DeMauro, David Gerald Tingay, Timothy D. Nelin, Patrick J. Peebles, Jennifer Unrau, Akira Nishisaki, Elizabeth E. Foglia, Ahmed Moussa, Michelle D. Tyler, Jae Hong Kim, M. Wagner, Devin McKissic, Ivana Brajkovic, Sabine Iben, Paul Wildenhain, Mihai Pula-Dumitrescu, Jennifer Rumpel, Beth Ann Johnson, Nicole Pouppirt, Sara E Peeples
article en

Abstract

Objective To evaluate the frequency and safety of nasal versus oral endotracheal intubation procedures in infants admitted to a neonatal intensive care unit (NICU). Design Retrospective cohort study. Setting 29 centres across seven countries from April 2017 to March 2025. Patients Infants <1 year of age undergoing endotracheal intubation. Main outcome measures Primary outcome was first course success, with course defined as all intubation attempts without a change in equipment, premedication or route. Secondary outcomes were first attempt success, adverse tracheal intubation-associated events (TIAEs), severe TIAEs and severe desaturations. Adjusted relative risks (aRR) were estimated using Poisson regression accounting for centre, patient, provider and procedural variables. Results Among 20 350 intubation courses (nasal 1057 (5.2%); oral 19 293 (94.8%)), nasal intubations occurred at 17 of 29 centres, with site-level use ranging from 0% to 99.2%. In fully adjusted models, nasal compared with oral intubation was associated with decreased course success (aRR 0.89; 95% CI 0.84 to 0.94, p<0.001), first attempt success and increased risk for severe desaturation. There were no significant differences in TIAEs. In a post-hoc analysis, these associations were not present at sites where intubations were predominantly performed via nasal route. Conclusions Nasal intubation may not be the preferred approach for infants in settings where it is infrequently performed but may achieve comparable or improved intubation-related outcomes in centres with established expertise.

Archives of Disease in Childhood Fetal & Neonatal
Cincinnati Children's Hospital Medical Center (US), Cleveland Clinic (US), Royal Children's Hospital (AU), Royal Women's Hospital (AU), Children's Hospital of Philadelphia (US), University of Wisconsin–Madison (US), The University of Melbourne (AU), University of Calgary (CA), Hospital of the University of Pennsylvania (US), Centre Hospitalier Universitaire Sainte-Justine (CA), Yale University (US), Comprehensive Cancer Center Vienna (AT), Children's Hospital Colorado (US), WakeMed (US), Seattle Children's Hospital (US), Dartmouth Psychiatric Research Center (US), Lurie Children's Hospital (US), Perinatal Institute (GB), Stanford Medicine (US), Children's Hospital at Dartmouth Hitchcock (US), Murdoch Children's Research Institute (AU), Rainbow Babies & Children's Hospital (US), University of Manitoba (CA), Case Western Reserve University (US), Medical University of Vienna (AT), University of Pennsylvania (US), University of Arkansas for Medical Sciences (US), University of Colorado Denver (US), Stanford University (US)
Good health and well-being
Openalex Percentile: Top 12%
Neonatal Respiratory Health Research
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.