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Feng SY, Rao S, Patole S. A Survey on Criteria for Intubation in Moderate to Late Preterm Infants With Respiratory Distress [published online ahead of print, 2020 Sep 4]. Pediatr Pulmonol. 2020;10.1002/ppul.25054. doi:10.1002/ppul.25054

Background: Majority of preterm infants do well with CPAP as the sole respiratory management; but some require endotracheal intubation and surfactant administration. Whilst intubation is needed predominantly in extremely preterm infants (<28 weeks); some of the more mature preterm infants also require it. Currently, there are no clear guidelines regarding indications for endotracheal intubation in such infants.

Aims: To understand the current practice regarding “criteria for intubation” in moderate to late preterm infants with respiratory distress.

Methods: A survey of neonatologists in Australia New Zealand Neonatal Network (ANZNN) was conducted between April and June 2019.

Results: At least one neonatologist each from 29 of the 30 tertiary ANZNN Neonatal Intensive Care Units (NICUs) responded to the survey. In total, 118/200 (59%) neonatologists responded. The most common criteria for intubation were CPAP=8cmH2 O (61%), pH <7.2 (55%), pCO2 >70mmHg (48%), FiO2 > 40% (40%), chest retractions (48%), more than two episodes of apnoea requiring intervention (54%), and chest x ray (CXR) showing moderate-severe hyaline membrane disease (HMD, 49%).

Conclusions: Whilst there were variations in practice, nearly 50% of the neonatologists shared a common threshold with regards to the CPAP level, FiO2 , blood gas parameters, and clinical and radiological findings. The results of this survey will help in designing future randomised controlled trials (RCTs) on this subject.

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