161 - Association of Neonatal Intubation Adverse Event and First-attempt Success with Night and Weekend Intubations

Poster Number: 161
Publication Number: 161.233

Rushabh Shah, University of Washington School of Medicine, Seattle, WA, United States; Taylor Sawyer, University of Washington, Seattle, WA, United States; Ahmed Moussa, Universite de Montreal Faculty of Medicine, Westmount, PQ, Canada; Brianna K. Brei, University of Nebraska College of Medicine, Omaha, NE, United States; Anne Ades, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kristen M. Glass, Penn State Health Milton S Hershey Medical Center, Hershey, PA, United States; Lindsay Johnston, Yale School of Medicine, New Haven, CT, United States; Philipp Jung, University Children's Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Schleswig-Holstein, Germany; Neetu Singh, DHMC, Lebanon, NH, United States; Bin Huey Quek, KK Women's and Children's Hospital, Singapore, N/A, Singapore; Shilpi Chabra, University of Washington School of Medicine, Seattle, WA, United States; Mihai Puia-Dumitrescu, University of Washington School of Medicine, Seattle, WA, United States; Sara Neches, UWMC, Seattle, WA, United States; James S. Barry, university of Colorado, centennial, CO, United States; Jeanne Zenge, University of Colorado School of Medicine, Aurora, CO, United States; Stephen D. DeMeo, WakeMed Children's Hospital WakeMed Health and Hospitals, Raleigh, NC, United States; Alicia Tisnic, alberta childrens Hospital, Calgary, AB, Canada; Ayman Abou Mehrem, University of Calgary, Calgary, AB, Canada; Jae H. Kim, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Jennifer Rumpel, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR, United States; Natalie Napolitano, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Vinay Nadkarni, University of Pennsylvania, CHOP, Philadelphia, PA, United States; Elizabeth Foglia, Perelman School of Medicine at the University of Pennsylvania, Swarthmore, PA, United States; Akira Nishisaki, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; David Tingay, Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Michael Wagner, Medical University of Vienna, Vienna, Wien, Austria

Background: Tracheal intubation adverse events (TIAE’s) are a common occurrence in the NICU. A prior study of pediatric intubation found a higher occurrence of TIAEs during nights and weekends. Little is known about the impact of time of day or day of the week on the incidence of TIAE’s in the NICU.  We hypothesized that the incidence of TIAEs would be higher, and that first-attempt intubation success rate would be lower during nights and weekends as compared to weekdays.

Objective: Compare the incidence of TIAE’s and first-attempt intubation success rates in neonatal intubations during nights and weekends as compared to weekdays.

Design/Methods: Retrospective multicenter cohort study using prospectively collected data from October 2014 to October 2020. “Weekdays” were defined as 07:00 to 18:59, Monday through Friday, “nights” as 19:00 to 06:59 the next morning, and “weekends” as Friday at 19:00 to 06:59 Monday morning. TIAEs included esophageal intubation, mainstem intubation, airway trauma, emesis with aspiration, dysrhythmia (including bradycardia with heart rate < 60 bpm), chest compressions, and cardiac arrest. First attempt success was defined as successful intubation on the first attempt by the first provider. The relationship between intubation time and day with TIAEs and intubation success was analyzed using univariate analysis.

Results: 8,160 NICU intubations were reported at 17 participating NICUs; 4,009 during nights and weekends and 4,151 during weekdays. Demographic data are provided in Table 1. TIAE’s occurred in 1,574 (19.3%) intubations and 328 (4%) were classified as severe. First attempt success was 53.8%. TIAE’s were more common on nights or weekends as compared to weekdays (811 (20.2%) vs. 763 (18.4%); P= 0.03) (Table 2). There was no difference in first-attempt success between nights or weekends and weekdays (2,135 (53.3%) vs. 2,259 (54.4%); P =0.3) (Table 2). The neonatal attending was present during intubation less often during nights or weekends as compared to weekdays (2,283 (56.9%) vs. 2,954 (71.2%); P < 0.001).Conclusion(s): Tracheal intubations during nights or weekends were associated with a higher occurrence of any TIAE’s, but similar first attempt success rates. Further analysis with multivariate logistic regression is planned to control for potential confounders and effect modifiers.
Rushabh.Shah_CVRushabh.Shah_CV.pdf
Outcomes AnalysisTable 2. Univariate Analysis of Primary and Secondary Outcomes