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Journal Club - safe emergency neonatal airway management - challenges and potential approaches

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On behalf of the 99nicu Team, I would like to invite you to participate in our 2nd Journal Club! 

The article we chose this time is a review article on "Safe emergency neonatal airway management: current challenges and potential approaches" by Joyce E O'Shea, Alexandra Scrivens, Gemma Edwards, and Charles Christoph Roehr. This artile is not Open Access, but I hope you can get it from your hospital library.

The review article examines how to acutely manage the neonatal airway, and the challenges related facemask ventilation and intubation.  Some of the key messages in this paper are:

  • Intubation success rates are low, especially for inexperienced trainees
  • Universal intubation competency for all pediatric and neonatal trainees and consultants may no longer be possible
  • Videolaryngoscopy can help increase rates
  • The laryngeal mask airway (LMA) is a promising alternative to intubation

Some of the questions we would like to discuss are:

  • What is current practice in your department? How to do you manage the airways and who is doing what?
  • What do you think are the strengths of this review article?
  • What do you think are some of the limitations?
  • Will this review have an impact in your department?
    • If no - why?
    • If yes, how?

We are looking forward to hearing your thoughts and opinions!

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There has been a lot of thoughts on this in the neonatal Twitter community!

is intubation a mandatory competency for trainees in your country? Should it be? How do you as a neonatal physician/ANNP/NNP keep your skills up to date? How many is “enough” to be deemed proficient?



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The point about the VL is an important one. If intubation becomes a high risk/low frequency event, we should take a safety perspective and engineer our systems for safety, not widespread procedural competency with direct laryngoscopy. I am a physician-scientist who primary covers a level IV NICU without a delivery service. The over all number of intubations is relatively low and in most emergency circumstances there is a front line provider (typically NNP), a (very) experienced charge NNP, and a neonatal fellow available for managing the airway while I run the code. I can now count on one hand the number of times per year I even pick up a laryngoscope outside of a simulation (and as often as not, given that several experienced providers have tried to intubate before me, I'm busy re-engineering the situation to improve success or avoid need for intubation rather than somehow getting the tube in when others could not). I am confident that I've probably reached the point where I am significantly safer/better with VL than DL. This isn't just about trainees any more.

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