Does anybody practice nasotracheal intubation in newborn? Any evidence for it?

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While most of my colleagues would go for an oral tube in an emergency situation (like during resuscitation after birth), we prefer nasal endotracheal intubation for babies we believe will need to be intubated for some time (semi-planned intubations).

With the exception of small preterm infants that are usually intubated nasally at birth, if they are likely to need MV/HFOV initially.

My personal opinion is that nasal tubes are not more difficult to insert, especially in smaller infants that can have little room orally and the tube can partly "hinder" view of the tracheal entrance.

Nursing-wise I guess there are lots of opinions and experiences that differ. Our take is that nasal tubes are better fixated, making nursing easier. But I am sure that units using mostly oral tubes don't consider nursing difficult.

Here are two rather recent and interesting references, the first one is a survey of practise from PICUs (maybe not so applicable to NICUs, but interestingly almost all children have oral tubes), the other one a review from Cochrane concluding that one route of intubation does not seem to be preferable to the other.

http://www.ncbi.nlm.nih.gov/pubmed/23328260

http://www.ncbi.nlm.nih.gov/pubmed/10796391/

Thanks a lot stefan.

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