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Neonatal endotracheal intubation
  1. J P Wyllie
  1. J P Wyllie, Department of Neonatology, The James Cook University Hospital, Marton Road, Middlesbrough TS4 3BW, UK; jonathan.wyllie{at}stees.nhs.uk

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Despite the fact that neonatal endotracheal intubation was described more than 2000 years ago,1 it was only in the 18th and 19th centuries that it began to be accepted as a worthwhile technique for ventilating lungs at birth.24 Nevertheless, the practice fell out of favour and many other strange methods were used to resuscitate babies at birth.5 However, in the early 20th century Flagg recommended endotracheal intubation for positive pressure ventilation of newly born babies in the USA6 and Blaikely and Gibberd made similar recommendations in the UK in 1935.7 Conversely, the only trial in humans of intubation at birth compared with the standard technique of resuscitation in a pressure chamber in 1966 found no difference between the two practices.8 It was with the developments in artificial respiration in the 1960s and 1970s that endotracheal intubation became an established part of the developing speciality of neonatal intensive care. Although it is now well established as a requirement for a few babies at birth and for infants receiving positive pressure ventilation, the interest in non-invasive ventilation and continuous positive airways pressure (CPAP)9 as alternatives underlines the lack of randomised human evidence for its use. This article will review some of the evidence and describe the technique of neonatal intubation.

WHY AND WHEN TO INTUBATE?

Endotracheal intubation is either an emergency or an elective/semi-elective procedure and examples of some indications are listed in table 1. Some intensive care units in the UK have experienced a reduction in emergency intubation at birth following the introduction of structured resuscitation training,10 although prior to this intubation rates varied from 1.5% to 12% depending upon the hospital.10 11 As few as 1 in 500 babies may need intubation at birth.12 However, it is clear that with less time …

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