Naseh Nima, Wallström Linda, Sindelar Richard, Ågren Johan
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Pediatr Res. 2025 Jun 18. doi: 10.1038/s41390-025-04186-8.
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.
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.
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.
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.
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.
关于极微小的超早产儿口腔气管插管（ETT）和脐动脉/静脉导管（UAC/UVC）的放置，相关建议有限。我们旨在确定最佳插入深度，并评估ETT位置过深对预后的影响。
对2019 - 2024年在瑞典乌普萨拉大学医院出生的孕周为22 - 23周的所有婴儿进行放射学评估，以确定准确位置，定义为：ETT（不在右侧/不在主支气管）、UAC（T6 - 9或L3 - 4）和UVC（右心房/下腔静脉交界处）。进一步分析ETT位置与首次拔管时间、呼吸严重程度评分、机械通气持续时间、支气管肺发育不良和死亡率的关系。
该队列（n = 75；22周n = 39；23周n = 36）的生存率分别为41%和64%。75%的ETT放置准确，较低的出生体重与导管尖端位置过深有关（p = 0.018）。最佳中位（IQR）插入深度为：ETT 5.5（5.5 - 6.0）；低位UAC 6.0（5.5 - 6.5）；高位UAC 9.6（9.2 - 10.3），UVC 5.5（5.0 - 6.1）厘米。ETT位置与呼吸预后或死亡率无关。
建议的插入深度有望使孕周为22 - 23周的婴儿的ETT和脐血管导管位置准确。
关于指导孕周为22 - 23周的婴儿在产房放置气管插管（ETT）和脐导管（UC）的信息有限。一项对ETT和UC标准化插入深度的评估，使用基于X射线的位置测量，证明了使用基于孕周的插入深度的可行性。建议的插入深度有望使孕周为22 - 23周的婴儿的ETT和UC尖端位置准确。
