Association of multiple tracheal intubation attempts with clinical outcomes in extremely preterm infants: a retrospective single-center cohort study

Objective We examined the association between the number of tracheal intubation (TI) attempts and clinical outcomes in extremely preterm infants. Method This is a single-center retrospective cohort study examining infants born at <= 28 weeks gestation intubated within the first four postnatal days. We analyzed infant, provider, and practice characteristics and clinical outcomes by exposure groups (1 vs. 2 vs. >= 3 TI attempts). Primary outcomes were death prior to NICU discharge or severe intraventricular hemorrhage (IVH). Result Ninety-nine infants were included. 46.5% required one TI attempt, 29.3% required two, and 24.2% required three or more. Increasing attempts was significantly associated with death (p = 0.004), adverse tracheal intubation-associated events (TIAEs; p = 0.004), and the training level of the first attempt provider (p = 0.002). No association was found with severe IVH or complications of prematurity. Conclusions Increasing attempts was associated with death and adverse TIAEs. Careful selection of providers could decrease adverse TIAEs and improve outcomes.