Intubation Attempts Increase the Risk for Severe Intraventricular Hemorrhage in Preterm Infants-A Retrospective Cohort Study

J Pediatr. 2016 Oct:177:108-113. doi: 10.1016/j.jpeds.2016.06.051. Epub 2016 Jul 26.


Objective: To evaluate whether neonates exposed to multiple intubation attempts within the first 4 days after birth have an increased incidence of intraventricular hemorrhage (IVH).

Study design: This is a retrospective cohort study of infants intubated during the first 4 days after birth. Infants had birth weights (BWs) less than 1500 g and were admitted to the neonatal intensive care unit (NICU) at the University of California, San Diego, between January 1, 2005, and July 30, 2009. A subgroup analysis was done for infants with BW less than 750 g.

Results: A total of 308 infants with BW <1500 g, including 102 with a BW <750 g, were intubated within the first 4 days of life. The number of intubation attempts was significantly greater in infants with a BW <750 g who had severe IVH compared with those with mild or no IVH (OR 1.395, 95% CI 1.090-1.786, P = .008). For infants with BW <1500 g, the number of intubation attempts in the delivery room was significantly greater for infants with severe IVH (OR 1.317, 95% CI 1.052-1.649, P = .016).

Conclusion: Increased intubation attempts were associated with increased incidence of severe IVH in infants with BW less than 750 g and in infants less than 1500 g who were intubated only in the delivery room. Prospective studies are needed to further evaluate the relationship between intubation attempts and severe IVH.

Keywords: Neonatal Intensive Care Unit; delivery room; neonate; resuscitation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cerebral Hemorrhage / epidemiology
  • Cerebral Hemorrhage / etiology*
  • Cohort Studies
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Very Low Birth Weight
  • Intensive Care Units, Neonatal
  • Intubation, Intratracheal / adverse effects*
  • Intubation, Intratracheal / statistics & numerical data
  • Male
  • Retrospective Studies
  • Risk