Video versus direct laryngoscopy for urgent tracheal intubation in neonates: a systematic review and meta-analysis.

Abstract

Introduction: Intubation is most often performed electively by anaesthetists in controlled conditions in operating theatres. In neonates, however, it is most often performed by neonatologists or paediatricians in urgent circumstances in the neonatal intensive care unit (NICU) or delivery room (DR). Neonatal intubation is a difficult skill to learn and maintain, and success rates are suboptimal both in the NICU and DR. Video laryngoscopy (VL) has the potential to increase intubation success and safety as it may offer a better view of the airway, which can be shared by the intubator and other clinicians.

Objectives: To compare the efficacy and safety of using VL to direct laryngoscopy (DL) for intubation of neonates in the NICU and DR.

Search methods: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL up to August 2024 without language restrictions.

Selection criteria: Randomised controlled trials (RCTs), quasi-RCTs, cluster-RCTs or cross-over trials that compared VL to DL for intubation of neonates outside of the neonatal operating theatre.

Main results: VL improves first attempt intubation success rates, 849 intubations (RR 1.46, 95% CI 1.21 to 1.75), with a number needed to treat (NNT) of 6.

Conclusions: VL improves intubation success rates without increasing adverse events and should be the standard of care for neonatal intubations in the NICU and DR.