Neonates' distinct airway architecture, low physiologic reserve, and quick propensity for hypoxemia during attempts make urgent tracheal intubation one of the most technically challenging operations in clinical practice. Clinicians have traditionally used direct laryngoscopy, which necessitates a clear line of sight in order to see the glottis.
However, a different method that provides an expanded, indirect image of the airway through a camera-equipped blade has emerged with the advent of video laryngoscopy. Neonates, whose tiny anatomical boundaries make visibility challenging and even slight delays might jeopardize oxygenation, are particularly drawn to this technique.
Although there are still concerns regarding video laryngoscopy's consistency across various gestational ages, clinical settings, and operator skill levels, preliminary data indicates that it may improve glottic vision and assist learners. Urgent intubations also frequently take place in high-stress environments, such neonatal critical care units or delivery rooms, when patient condition, team familiarity, and equipment availability might affect effectiveness.
Neonatal teams' training priorities and airway management tactics can be improved by knowing the relative advantages and disadvantages of these two approaches. Determining whether video laryngoscopy should supplement or replace direct laryngoscopy during urgent newborn intubation is still a crucial issue as technology advances. Thus, this study was assessed the safety and effectiveness of employing VL against direct laryngoscopy (DL) for neonatal intubation in the NICU and delivery room (DR).
Up to August 2024, researchers conducted unrestricted searches in Embase, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials. RCTs, quasi-RCTs, cluster-RCTs, or cross-over studies that contrasted video laryngoscopy with direct laryngoscopy for newborn intubation outside of the neonatal operating room.
The key findings of this study highlighted that with 849 intubations (RR 1.46, 95% CI 1.21 to 1.75) and a number required to treat (NNT) of 6, video laryngoscopy increases first attempt intubation success rates. Overall, in both the neonatal unit and the delivery room, video laryngoscopy should be the standard of care for newborn intubation, especially in cases where the intubator lacks expertise.
Reference:
Donaldson, N., O’Donnell, C. P. F., Roehr, C. C., Adams, E., Bartle, D. G., Geraghty, L. E., Tinnion, R., & O’Shea, J. E. (2025). Video versus direct laryngoscopy for urgent tracheal intubation in neonates: a systematic review and meta-analysis. Archives of Disease in Childhood. Fetal and Neonatal Edition, 110(6), 526–531. https://doi.org/10.1136/archdischild-2024-327555
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