Video Laryngoscopy Improves intubation success, Should Be Standard for Neonatal Intubation: Study
A new study published in the Archives of Disease in Childhood, Fetal and Neonatal Edition showed that video laryngoscopy (VL) is the standard of treatment for newborn intubations in the neonatal intensive care unit (NICU) and delivery room because it increases intubation success rates without increasing adverse effects.
Neonates have distinct airway architecture, low physiologic reserve, and a rapid tendency toward hypoxemia during attempts, making urgent tracheal intubation one of the most technically challenging procedures in clinical practice. Traditionally, clinicians have used direct laryngoscopy, which requires a clear line of sight to visualize the glottis.
With the advent of video laryngoscopy, a technique providing an expanded, indirect airway view through a camera-equipped blade has emerged. This approach is particularly useful in neonates, where small anatomical dimensions and even brief delays can compromise oxygenation.
Although concerns remain regarding consistency across gestational ages, clinical settings, and operator skill levels, early evidence suggests that video laryngoscopy improves glottic visualization and supports trainee performance. Urgent intubations often occur in high-stress environments such as neonatal intensive care units or delivery rooms, where patient condition, team familiarity, and equipment availability influence outcomes.
Understanding the advantages and limitations of video versus direct laryngoscopy can help refine neonatal airway management strategies. As technology evolves, determining whether video laryngoscopy should replace or supplement direct laryngoscopy remains an important question. This study evaluated the safety and effectiveness of video laryngoscopy compared with direct laryngoscopy for neonatal intubation in the NICU and delivery room.
Up to August 2024, researchers conducted unrestricted searches in Embase, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials. Randomized and quasi-randomized trials comparing video laryngoscopy with direct laryngoscopy for neonatal intubation outside the operating room were included.
Key findings showed that among 849 intubations, video laryngoscopy significantly improved first-attempt success rates (RR 1.46; 95% CI 1.21–1.75), with a number needed to treat of 6. Overall, video laryngoscopy should be considered the standard of care for newborn intubation in both the NICU and delivery room, particularly when operator experience is limited.
Reference:
Donaldson N, O’Donnell CPF, Roehr CC, Adams E, Bartle DG, Geraghty LE, Tinnion R, O’Shea JE. (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
