Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia

Allison C. Young; Joseph L. Hagan; Shweta S. Parmekar; Pamela M. Ketwaroo; Nathan C. Sundgren

doi:10.1055/a-2370-2035

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(03): 395-400
DOI: 10.1055/a-2370-2035

Original Article

Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia

Allison C. Young

¹Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas

,

Joseph L. Hagan

²Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas

,

Shweta S. Parmekar

²Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas

,

Pamela M. Ketwaroo

³Department of Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas

,

Nathan C. Sundgren

²Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas

› Author Affiliations

Abstract

Objective This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates.

Study Design This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates.

Results The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, p < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, p < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, p < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, p < 0.001) estimates.

Conclusion Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH.

Key Points

CDH patients present unique stabilization challenges.
Standard ETT depth estimates are too shallow.
Resuscitation teams should cautiously choose ETT depth.

Keywords

congenital diaphragmatic hernia - endotracheal tube - intubation - neonate - resuscitation

Full Text

References

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