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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
1   Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Joseph L. Hagan
2   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Shweta S. Parmekar
2   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Pamela M. Ketwaroo
3   Department of Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
,
Nathan C. Sundgren
2   Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas
› Author Affiliations Funding None.
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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


Publication History

Received: 10 May 2024

Accepted: 19 July 2024

Accepted Manuscript online:
22 July 2024

Article published online:
13 August 2024

© 2024. Thieme. All rights reserved.

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