Standardized endotracheal tube and intravascular access placement in infants born at 22-23 weeks gestation.

BACKGROUND

Recommendations are limited regarding the placement of oral endotracheal tube (ETT), and umbilical arterial/venous catheter (UAC/UAC) in the tiniest extremely preterm infants. We aimed to determine optimal insertion depths, and assess the impact of a too deep ETT position on outcomes.

METHODS

All infants born at 22-23 weeks gestation in 2019-2024 at Uppsala University Hospital, Sweden, were evaluated radiologically for accurate positions defined as: ETT (not right-sided/in main bronchus), UAC (T6-9 or L3-4), and UVC (right atrium/inferior vena cava junction). ETT position was further analyzed in relation to time to first extubation, respiratory severity score, duration of mechanical ventilation, bronchopulmonary dysplasia, and mortality.

RESULTS

The cohort (n = 75; 22w n = 39; 23w n = 36) had a survival rate of 41 and 64%, respectively. The ETT was accurately placed in 75%, and lower birth weight was associated with a too deep tip position (p = 0.018). The optimal median (IQR) insertion depths were: ETT 5.5 (5.5-6.0); low UAC 6.0 (5.5-6.5); high UAC 9.6 (9.2-10.3), and UVC 5.5 (5.0-6.1) cm. ETT position was not associated with respiratory outcomes or mortality.

CONCLUSION

The suggested insertion depths can be expected to result in accurate positioning of ETTs and umbilical lines in infants born at 22-23 weeks gestation.

IMPACT

There is limited information to guide delivery room placement of endotracheal tube (ETT) and umbilical catheters (UC) in infants born at a gestational age (GA) of 22-23 weeks. An evaluation standardized insertion depths for ETT and UC, with use of x-ray based measurements of their positions, demonstrate the feasibility of using GA-based insertion depths. The suggested insertion depths can be expected to result in accurate ETT and UC tip positions in infants born at 22-23 weeks.