Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan.
Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan.
Pediatr Int. 2020 Aug;62(8):932-936. doi: 10.1111/ped.14245. Epub 2020 Jul 19.
Appropriate management of the endotracheal tube (ETT) insertion depth is important. The depth calculated using Tochen's formula is overestimated in extremely-low- birthweight infants, particularly those with a birthweight <750 g. Gestational age has been shown to be particularly useful in the Neonatal Resuscitation Program, 7th edition. However, a randomized trial for estimating the ETT insertion depth failed to show the advantage of using gestational age over birthweight. Therefore, we aimed to estimate the appropriate ETT insertion depth in neonates weighing <750 g.
This was a single-center, retrospective observational study including neonates weighing <750 g who required intubation. The appropriate depth was determined by adjusting the distance between the actual ETT position and the area from the first to the second thoracic vertebra on the radiograph. Correlations between gestational age and physique were investigated using Pearson's correlation coefficient. We examined small-for- gestational-age (SGA) infants and non-SGA infants separately.
Forty neonates were enrolled in this study. The mean gestational age and birthweight were 26.3 weeks and 620 g respectively. Twenty infants were SGA. The ETT position was deep in 35 of 40 cases, with the strongest correlation between weight and ETT insertion depth. The correlation with gestational age was not observed in this study.
Our study showed that the ideal ETT insertion depth at birth correlates with birthweight in neonates weighing <750 g. Therefore, determination by gestational age may not be feasible in populations with a high proportion of SGA infants.
妥善管理气管内导管（ETT）的插入深度非常重要。Tochen 公式计算出的深度在极低出生体重儿中被高估，尤其是那些出生体重<750g 的婴儿。胎龄在新生儿复苏计划第七版中已被证明特别有用。然而，一项估计 ETT 插入深度的随机试验未能显示出使用胎龄优于出生体重的优势。因此，我们旨在估计体重<750g 的新生儿的合适 ETT 插入深度。
这是一项单中心、回顾性观察性研究，包括需要插管的体重<750g 的新生儿。通过调整实际 ETT 位置与 X 线片上第一至第二胸椎区域之间的距离来确定合适的深度。使用 Pearson 相关系数研究胎龄与体型之间的相关性。我们分别检查了小于胎龄儿（SGA）和非 SGA 婴儿。
本研究共纳入 40 名新生儿。平均胎龄和出生体重分别为 26.3 周和 620g。20 名婴儿为 SGA。40 例中有 35 例 ETT 位置过深，体重与 ETT 插入深度的相关性最强。本研究未观察到与胎龄的相关性。
我们的研究表明，体重<750g 的新生儿出生时理想的 ETT 插入深度与出生体重相关。因此，在 SGA 婴儿比例较高的人群中，通过胎龄来确定可能不可行。
