The Effect of Endotracheal Tube (ETT) Tip Position on Lung Aeration in Term and Preterm Neonates: A Comparative Analysis.

BACKGROUND

Proper endotracheal tube (ETT) position is crucial for neonatal lung aeration. The purpose of this study is to determine the effect of ETT tip position on lung aeration in term and preterm infants.  Methods: This retrospective chart study involved neonates who were admitted to the Neonatal Intensive Care Unit (NICU) and intubated, and it was carried out from February 2023 to July 2023 at the Sindh Institute of Child Health and Neonatology. ETT tip position was analyzed, and chest x-rays (CXRs) were obtained within four hours of intubation. On a CXR, lung expansion evident to eight or eight and a half ribs was considered adequate lung inflation/aeration; fewer than eight ribs were considered poor lung inflation/aeration. To ascertain relationships between ETT tip location and lung aeration, data were examined using the chi-square test in SPSS version 26 (IBM Corp., Armonk, NY).

RESULTS

Out of 149 neonates, 105 (70.5%) were preterm and 44 (29.5%) were term. Optimal lung aeration was observed in 124 neonates (83.2%). The ETT tip was positioned at T1-T2 in 86 neonates (57.7%) and at T3-T4 in 63 neonates (42.3%). For term neonates, those with the ETT tip at T1-T2 exhibited significantly higher rates of optimal lung aeration (72.2%) compared to those with the tip at T3-T4 (27.8%, p = 0.019). Conversely, no significant difference in lung aeration was noted among preterm neonates based on ETT position (p = 0.745).

CONCLUSIONS

In conclusion, our study found a significant association between ETT tip positioning at T1-T2 and optimal lung aeration in term neonates. This suggests that precise ETT placement may play an important role in achieving better lung aeration in term infants, while slight positional deviations may be less impactful for lung aeration in preterm neonates. These findings may guide NICU protocols to consider gestational age when tailoring ventilation strategies, emphasizing the importance of anatomical and physiological differences in neonatal respiratory care.