Video laryngoscopy in neonate and infant intubation-a systematic review and meta-analysis.

We aimed to analyze the effect of video laryngoscopy on intubation success, time to intubation, and adverse events in infants and neonates. A systematic review and meta-analysis was performed, for which a neonates (age less than 29 days) and infants (age less than 365 days) needing to be intubated were included. The main outcomes were first attempt success rate in the intubation, time to intubation, and adverse events. Evidence certainty was assessed according to GRADE. We included 13 studies. Seven studies with 897 patients focused on neonates, and the first attempt success rate was higher in the video laryngoscopy group (RR 1.18, CI: 1.03-1.36). Six studies included 1039 infants, and the success rate was higher in the video laryngoscopy group (RR 1.06, CI: 1.00-1.20). Time to intubation was assessed in 11 trials, and there was no difference between the groups (mean difference 1.2 s, CI - 2.2 s to + 4.6 s). Odds of desaturation (OR 0.62, CI 0.42-0.93) and nasal/oral trauma (OR 0.24, CI 0.07-0.85) were lower in the video laryngoscopy group. Evidence certainties varied between moderate and low.

Conclusion: We found moderate certainty evidence that the use of video laryngoscopy improves first attempt success rates in neonate and infant intubations, while the time to intubation did not differ between video and direct laryngoscopy groups. Further studies are still needed to improve the first intubation success rates in neonates.

What is known: • Video laryngoscopy has been shown to improve first-pass intubation success rates and reduce time to intubation in adults and older children.

What is new: • Video laryngoscopy improved the first attempt intubation success rates both in neonates and in infants. • Video laryngoscopy did not increase the time to intubation, and it was associated with less adverse events than direct laryngoscopy.