The DR and NICU serve different purposes in the stabilization of organ systems, development, and growth. Endotracheal intubation (ETI) of neonates in delivery rooms (DR) and neonatal intensive care units (NICU) is a procedure associated with a risk of complications and airway injury.
Airway management is a core skill in neonatology and anesthesiology. Of these 3–10% may not respond to mask ventilation leading to an attempt to intubate ( 1– 3). Roughly 5% of newborns need respiratory support such as positive pressure ventilation (PPV) to successfully overcome the phase from fetal to extrauterine life. The regional and national referral hospital that cares for most of the extremely pre-term infants in the region, is located only 21 km away. At cesarean deliveries, more rarely in vaginal deliveries, one or more anesthesiologists is/are present for the care of the mother and will offer assistance if the neonate is depressed and requires resuscitation. The neonatal resuscitation team is called for when a baby is in unexpectedly poor condition at birth, and consists of a pediatric resident, a consultant neonatologist (or pediatrician) and a nurse from the NICU. A pediatric resident and a general pediatrician are responsible for initial resuscitation and stabilization of newborns in the evening and nighttime with an on-call neonatologist at home with a 30-min response time. Our recommendations mainly pertain to DR resuscitations but may be transferred to the NICU environment.Īkershus University Hospital (AUH) has ~5.000 deliveries per year and the level 2–3 NICU provides care for newborn infants from 26 weeks gestation. We learned from observing current approaches to advanced airway management in DR resuscitations in a university hospital and make recommendations on how the neonatal difficult airway may be managed through technical and non-technical approaches. Experience from anesthesiology is that a “difficult airway algorithm,” advance planning and routine practicing, prepares the resuscitation team to respond adequately to the technical and non-technical stress of a difficult airway situation. While a recent guideline from the British Pediatric Society exists, and the Scottish NHS and Advanced Resuscitation of the Newborn Infant (ARNI) airway management algorithm was recently revised, there is no Norwegian national guideline for managing the unanticipated difficult airway in the delivery room (DR) and neonatal intensive care unit (NICU).
Despite this, a well-defined in-house approach to the neonatal difficult airway is often lacking. As bradycardia and cardiac arrest in the neonate are usually of respiratory origin, neonatal airway management remains a critical factor.
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