PC1081: Comparing Intubation Rates in the Delivery Room by Interface

Background: Positive pressure ventilation (PPV) is crucial to the resuscitation of newborns. Although neonates frequently require PPV at birth, the optimal interface has not been determined. Both bi-nasal prongs and face masks were deemed acceptable by the International Liaison Committee on Resuscitation in 2010 and have been utilized at our center since 2016, however the choice is by provider preference. Previous studies have suggested bi-nasal prongs may be more effective than traditional face masks at avoiding intubation in the delivery room.

Methods: This retrospective study included neonates < 30 weeks’ gestation born between August 2016 - April 2021 at our level IV NICU. Exclusion criteria included diagnosis of congenital diaphragmatic hernia, no PPV required, or no resuscitation attempted. Data collected included interface device, demographics, maternal data, delivery room data, admission data and discharge outcomes. The 3 interface groups (bi-nasal prongs, face mask, face mask and bi-nasal prongs) were compared utilizing chi-square and ANOVA testing with post-hoc analysis as well as binary logistic regression.

Results: Of 303 patients included in the study, 93 were resuscitated with bi-nasal prongs (30.7%), 169 with face mask (55.8%), and 41 with face mask and bi-nasal prongs (13.5%). The data revealed infants in the face mask group tended to be younger and smaller with higher rates of maternal general anesthesia. They also had lower APGAR scores and cord base deficits (Figure 1). Short term outcomes of infants in the bi-nasal prongs group included less intubation in the delivery room, higher rates of INSURE and less intubation at 6 hours of life (Figure 2). We created a binary logistic regression model which revealed that the risk of intubation with face mask resuscitation was 19.6x greater than that of bi-nasal prongs and accounted for a larger portion of intubation in the delivery room than either general anesthesia or gestational age. Discharge outcomes included higher rates of mortality and chronic lung disease in the face mask group, however this was accounted for by gestational age and birthweight.

Conclusion: Bi-nasal prongs appear to be safe and effective in avoiding intubation in the delivery room. Prospective studies are warranted. Bi-nasal prongs may especially be beneficial for resuscitation in centers where intubation of premature infants is an infrequent occurrence.