Nasal insertion depths for neonatal intubation

2020 ◽  
Vol 105 (6) ◽  
pp. 663-665
Author(s):  
Christian Achim Maiwald ◽  
Patrick Neuberger ◽  
Ingo Mueller-Hansen ◽  
Rangmar Goelz ◽  
Jörg Michel ◽  
...  
Keyword(s):  
Body Weight ◽  
Endotracheal Tube ◽  
Gestational Age ◽  
Thoracic Vertebrae ◽  
Nasal Intubation ◽  
X Rays ◽  
Insertion Depth

AimData on the depth of nasal intubation in neonates are rare, although this is the preferred route in some countries. Therefore, recommendations on optimal nasal intubation depths based on gestational age (GA) and weight are desirable.MethodsWe determined the distances between the middle of thoracic vertebrae 2 (T2) and the tip of the endotracheal tube in 116 X-rays from nasally intubated neonates. The intubation depth (tip to nostril distance) that was documented in the digital patient’s file was then corrected for this distance to reach an optimal nasal insertion depth. Results were plotted against the infant’s GA and weight.ResultsGA-based and birthweight-based charts and formulas for the nasal intubation depth in infants with a GA between 24 and 43 weeks and body weight between 400 and 4500 g were created.ConclusionsGenerated data may help in predicting optimal insertion depths for nasal intubation in neonates.

Is Nasal Septum–Tragus Length Measurement Appropriate for Endotracheal Tube Intubation Depth in Neonates? A Randomized Controlled Study

2019 ◽  
Author(s):  
Özgün Uygur ◽  
Mehmet Yekta Öncel ◽  
Gülsüm Kadıoğlu Şimşek ◽  
Nilüfer Okur ◽  
Kıymet Çelik ◽  
...  
Keyword(s):  
Birth Weight ◽  
Endotracheal Tube ◽  
Gestational Age ◽  
Nasal Septum ◽  
Tube Placement ◽  
Controlled Study ◽  
Proper Place ◽  
Insertion Depth ◽  
Randomized Controlled ◽  
Very High

Abstract Objective Endotracheal intubation is a frequent procedure performed in neonates with respiratory distress. Clinicians use different methods to estimate the intubation insertion depth, but, unfortunately, the improper insertion results are very high. In this study, we aimed to compare the two different methods (Tochen's formula = weight in kilograms + 6 cm; and nasal septum–tragus length [NTL] + 1 cm) used to determine the endotracheal tube (ETT) insertion depth. Study Design Infants who had intubation indications were enrolled in this study. The intubation tube was fixed using the Tochen formula (Tochen group) or the NTL + 1 cm formula (NTL group). After intubation, the chest radiograph was evaluated (above T1, proper place, and below T2). Results A total of 167 infants (22–42 weeks of gestational age) were included in the study. The proper tube placement rate in both groups was similar (32.4 vs. 30.4% for infants < 34 weeks of gestational age and 56.8 vs. 45.0% in infants > 34 weeks of gestational age). The ETT was frequently placed below T2 at a higher rate in infants with a gestational age of <34 weeks, especially in the NTL group (46% in the Tochen group and 60.7% in the NTL group). Conclusion The NTL + 1 cm formula led to a higher rate of ETT placement below T2, especially in infants with a birth weight of <1,500 g. Therefore, more studies are needed to determine the optimal ETT insertion depth.

scholarly journals Weight Is More Accurate than Gestational Age When Estimating the Optimal Endotracheal Tube Depth in Neonates

Children ◽  
2021 ◽  
Vol 8 (5) ◽  
pp. 324
Author(s):  
Hsien-Kuan Liu ◽  
Yung-Ning Yang ◽  
Shu-Leei Tey ◽  
Pei-Ling Wu ◽  
San-Nan Yang ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Gestational Age ◽  
Linear Regression Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Insertion Depth ◽  
Optimal Depth ◽  
Key Factor ◽  
Group 2 ◽  
Two Parameters ◽  
Group 1

Determining the optimal endotracheal tube (ETT) depth in neonates remains challenging for neonatologists. The guideline for optimal ETT depth is based on the patients’ weight or gestational age. However, there is a discrepancy in the suggested ETT depth between these two parameters. The aim of this retrospective study was to compare the recommended weight-based and age-based formulas for optimal ETT depth and obtain the optimal reference before intubation. Participants were assigned to group 1 if the recommended ETT insertion depth based on weight was concordant with the recommended depth based on gestational age, and to group 2 if the weight and age-based depth recommendations were discordant. After exclusion, 180 patients were included in the analysis. Results indicated that the predicted ETT depth suggested by age required more adjustment than by weight (p < 0.05). Furthermore, the required adjustment in the weight-based formula was smaller than the age-based formula (p < 0.05). Multivariate linear regression analysis revealed that weight was the key factor affecting the optimal depth (p < 0.001). These results imply that when there is a discrepancy in ETT depth between the weight-based and age-based recommendation, the weight-based one will be more accurate than the age-based one.

scholarly journals Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy

2021 ◽  
pp. 014556132098051
Author(s):  
Matula Tareerath ◽  
Peerachatra Mangmeesri
Keyword(s):  
Body Mass Index ◽  
Endotracheal Tube ◽  
Body Mass ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
The Body ◽  
Insertion Depth ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size ◽  
Actual Size

Objectives: To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. Patients and Methods: Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. Results: Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. Conclusion: Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < −2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.

scholarly journals Composition of the human foetus

1972 ◽  
Vol 27 (2) ◽  
pp. 305-312 ◽  
Author(s):  
Sharad V. Apte ◽  
Leela Iyengar
Keyword(s):  
Body Composition ◽  
Body Weight ◽  
Gestational Age ◽  
Maternal Nutrition ◽  
The Body ◽  
Human Foetus ◽  
Free Weight ◽  
Body Weights ◽  
Calcium Phosphorus ◽  
Ca:P Ratio

1. The body composition was determined of forty-one fetuses of different gestational ages born to mothers belonging to a low socio-economic group of the population.2. With increasing gestational age the water content fell from 88% at 28 weeks to 76% at term; the fat content increased from 2.1% to 11.2% and the protein content increased from 6.9 to 9.3%.3. The changes in body composition were more closely related to body-weight than to gestational age.4. The calcium, Phosphorus and magnesium contents of the body per unit fat-free weight progressively increased with gestational age, and at term the values appeared to be considerably lower than those reported in the literature. The Ca:P ratio was constant at different body-weights.5. The body iron content per unit of fat-free weight increased marginally with increasing gestational age. The value was almost 30% lower than the values reported from elsewhere.6. It is suggested that chemical composition and nutrient stores of the developing foetus can be considerably influenced by the state of maternal nutrition.

Impact of prenatal exercise on neonatal and childhood outcomes: a systematic review and meta-analysis

2018 ◽  
Vol 52 (21) ◽  
pp. 1386-1396 ◽  
Author(s):  
Margie H Davenport ◽  
Victoria L Meah ◽  
Stephanie-May Ruchat ◽  
Gregory A Davies ◽  
Rachel J Skow ◽  
...  
Keyword(s):  
Systematic Review ◽  
Body Weight ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Body Fat ◽  
Gestational Age ◽  
Fat Body ◽  
Meta Analysis ◽  
Prenatal Exercise ◽  
Frequency Intensity

ObjectiveWe aimed to identify the relationship between maternal prenatal exercise and birth complications, and neonatal and childhood morphometric, metabolic and developmental outcomes.DesignSystematic review with random-effects meta-analysis and meta-regression.Data sourcesOnline databases were searched up to 6 January 2017.Study eligibility criteriaStudies of all designs were eligible (except case studies and reviews) if published in English, Spanish or French, and contained information on the relevant population (pregnant women without contraindication to exercise), intervention (subjective/objective measures of frequency, intensity, duration, volume or type of exercise, alone (‘exercise-only’) or in combination with other intervention components (eg, dietary; ‘exercise+cointervention’)), comparator (no exercise or different frequency, intensity, duration, volume, type or trimester of exercise) and outcomes (preterm birth, gestational age at delivery, birth weight, low birth weight (<2500 g), high birth weight (>4000 g), small for gestational age, large for gestational age, intrauterine growth restriction, neonatal hypoglycaemia, metabolic acidosis (cord blood pH, base excess), hyperbilirubinaemia, Apgar scores, neonatal intensive care unit admittance, shoulder dystocia, brachial plexus injury, neonatal body composition (per cent body fat, body weight, body mass index (BMI), ponderal index), childhood obesity (per cent body fat, body weight, BMI) and developmental milestones (including cognitive, psychosocial, motor skills)).ResultsA total of 135 studies (n=166 094) were included. There was ‘high’ quality evidence from exercise-only randomised controlled trials (RCTs) showing a 39% reduction in the odds of having a baby >4000 g (macrosomia: 15 RCTs, n=3670; OR 0.61, 95% CI 0.41 to 0.92) in women who exercised compared with women who did not exercise, without affecting the odds of growth-restricted, preterm or low birth weight babies. Prenatal exercise was not associated with the other neonatal or infant outcomes that were examined.ConclusionsPrenatal exercise is safe and beneficial for the fetus. Maternal exercise was associated with reduced odds of macrosomia (abnormally large babies) and was not associated with neonatal complications or adverse childhood outcomes.

scholarly journals Morphofunctional features of platelets in premature newborns with very low and extremely low body weight

2021 ◽  
Vol 12 (2) ◽  
pp. 35-41
Author(s):  
Anastasia V. Budalova ◽  
Natalia V. Kharlamova ◽  
Galina N. Kuzmenko
Keyword(s):  
Body Weight ◽  
Platelet Count ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Gestational Age ◽  
Growth Retardation ◽  
Intrauterine Growth Retardation ◽  
Distress Syndrome ◽  
Premature Newborns ◽  
Intrauterine Growth

Background. Currently, the development of medicine in the field of perinatology is aimed at improving the quality of medical care for newborns, especially those born prematurely. Premature newborns are most likely to develop hemorrhagic disorders, which often aggravates their condition and determines high morbidity and mortality. On modern hematological analyzers, it has become possible to evaluate a larger number of blood parameters, including platelet parameters, however, there are a small number of studies devoted to the study of platelet parameters in premature newborns. The aim was to study the morphofunctional features of platelets in premature newborns with very low and extremely low body weight. Materials and methods. The study included 78 newborns born at 2534 weeks of gestation, with a body weight of less than 1500 grams. On the 3rd5th day of life, a clinical blood test was performed on the Advia 2120i hematological analyzer (Siemens), with the determination of platelet parameters: PLT, 103 cells/l, PCT, %, PDW, %, Large Plt, 103 cells/l, MPC, g/dl, MRM, pg. Results. In newborns with ELBW, a decrease in the number and granularity of platelets in the blood, an increase in the average dry mass of platelets was found. Newborns with intrauterine growth retardation have a reduced platelet count and reduced thrombocrit. In premature newborns with a gestational age of 2527 weeks, blood circulation of platelets with a reduced volume was established, and in newborns who were born at a gestational age of 3234 weeks with increased granularity. In the absence of antenatal prevention of respiratory distress syndrome in newborns, there is a decrease in thrombocrit, the number of platelets, including large forms in the blood. In premature newborns born in a state of severe asphyxia, a decrease in platelet granularity was noted. The use of high concentrations of O2 in the oxygen-air mixture during respiratory therapy leads to a decrease in the number of platelets in the blood. Conclusions. Factors determining the morphofunctional state of platelets in premature newborns were established: the presence of a full course of antenatal prevention of respiratory distress syndrome of newborns, gestational age, the severity of asphyxia at birth, as well as the concentration of O2 in the oxygen-air mixture used in respiratory therapy. Newborns with ELBW have a reduced platelet count, low-granulated platelets, and an increased average dry platelet mass. Newborns with intrauterine growth retardation have a reduced number of platelets and thrombocrit in the blood. The revealed morphofunctional features of platelets allow us to clarify the nature of changes in the platelet link of hemostasis in premature newborns for the timely prevention of complications during the underlying disease.

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