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Intubación orotraqueal en lactantes realizada con y sin estilete

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References

References to studies included in this review

Kamlin 2013 {published data only}

Kamlin CO, O’Connell LA, Morley CJ, Dawson JA, Donath SM, O’Donnell CPF, et al. A randomized trial of stylets for intubating newborn infants. Pediatrics 2013;131(1):e198‐205. [DOI: 10.1542/peds.2012‐0802; PUBMED: 23230069]CENTRAL

References to studies excluded from this review

Fisher 1997 {published data only}

Fisher QA, Tunkel DE. Lightwand intubation of infants and children. Journal of Clinical Anaesthesia 1997;9(4):275‐9. [PUBMED: 9195348]CENTRAL

MacNab 1998 {published data only}

MacNab AJ, MacPhail I, MacNab MK, Noble R, O'Flaherty D. A comparison of intubation success for paediatric transport team paramedics using lighted vs regular tracheal tube stylets. Paediatric Anaesthesia 1998;8(3):215‐20. [PUBMED: 9608966]CENTRAL

Shukry 2005 {published data only}

Shukry M, Hanson RD, Koveleskie JR, Ramadhyani U. Management of the difficult pediatric airway with Shikani Optical Stylet. Paediatric Anaesthesia 2005;15(4):342‐5. [DOI: 10.1111/j.1460‐9592.2005.01435.x; PUBMED: 15787929]CENTRAL

Yamashita 2015 {published data only}

Yamashita S, Takahashi S, Osaka Y, Fujikura K, Tabata K, Tanaka M. Efficacy of the transillumination method for appropriate tracheal tube placement in small children: a randomized controlled trial. Journal of Clinical Anesthesia 2015;27(1):12‐6. [doi: 10.1016/j.jclinane.2014.09.003; PUBMED: 25457173]CENTRAL

Additional references

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Bhargava M, Pothula SN, Joshi S. The obstruction of an endotracheal tube by the plastic coating sheared from a stylet: a revisit. Anesthesiology 1998;88(2):548‐9. [PUBMED: 9477085]

Boyd 1999

Boyd RL, Bradfield HA, Burton EM, Carter BS. Fluoroscopy‐guided retrieval of a sheared endotracheal stylet sheath from the tracheobronchial tree in a premature infant. Pediatric Radiology 1999;29(8):575‐7. [DOI: 10.1007/s002470050650; PUBMED: 10415179]

Carbajal 2007

Carbajal R, Eble B, Anand KJ. Premedication for tracheal intubation in neonates: confusion or controversy?. Seminars in Perinatology 2007;31(5):309‐17. [DOI: 10.1053/j.semperi.2007.07.006; PUBMED: 17905186]

Chiou 2007

Chiou HL, Diaz R, Orlino E, Poulain FR. Acute airway obstruction by a sheared endotracheal intubation stylet sheath in a premature infant. Journal of Perinatology 2007;27(11):727‐9. [DOI: 10.1038/sj.jp.7211829; PUBMED: 17960145]

Cook 1985

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Dempsey 2006

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Haubner 2013

Haubner LY, Barry JS, Johnston LC, Soghier L, Tatum PM, Kessler D, et al. Neonatal intubation performance: room for improvement in tertiary neonatal intensive care units. Resuscitation 2013;84(10):1359–64. [DOI: 10.1016/j.resuscitation.2013.03.014; PUBMED: 23562374]

Higgins 2003

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Higgins 2011b

Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. www.cochrane‐handbook.org.

ILCOR 2005

International Liaison Committee on Resuscitation. 2005 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 7: neonatal resuscitation.. Resuscitation 2005;67(2‐3):293‐303. [DOI: 10.1016/j.resuscitation.2005.09.014; PUBMED: 16324993]

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Kattwinkel J, Short J, Shavell L, Siede B. Textbook of Neonatal Resuscitation. 5th Edition. Elk Grove, IL: American Academy of Pediatrics, 2006.

Lane 2004

Lane B, Finer N, Rich W. Duration of intubation attempts during neonatal resuscitation. Journal of Pediatrics 2004;145(1):67‐70. [DOI: 10.1016/j.jpeds.2004.03.003; PUBMED: 15238909]

Lemyre 2009

Lemyre B, Cheng R, Gaboury I. Atropine, fentanyl and succinylcholine for non‐urgent intubations in newborns. Archives of Disease in Childhood. Fetal and Neonatal Edition 2009;94(6):F439‐42. [DOI: 10.1136/adc.2008.146068; PUBMED: 19307222]

Leone 2005

Leone TA, Rich W, Finer NN. Neonatal intubation: success of pediatric trainees. Journal of Pediatrics 2005;146(5):638‐41. [DOI: 10.1016/j.jpeds.2005.01.029; PUBMED: 15870667]

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Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL. Physiologic changes associated with endotracheal intubation in preterm infants. Critical Care Medicine 1984;12(6):501–3. [PUBMED: 6723333]

McAuliffe 1995

McAuliffe G, Bissonnette B, Boutin C. Should the routine use of atropine before succinylcholine in children be reconsidered?. Canadian Journal of Anaesthesia 1995;42(8):724‐9. [DOI: 10.1007/BF03012672; PUBMED: 7586113]

Meneghini 2000

Meneghini L, Zadra N, Metrangolo S, Narne S, Giusti F. Post‐intubation subglottal stenosis in children: risk factors and prevention in pediatric intensive care. Minerva Anestesiologica 2000;66(6):467‐71. [PUBMED: 10961059]

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Nishiasaki A, Donoghue AJ, Colburn S, Watson C, Meyer A, Brown CA, et al. Effect of just‐in‐time simulation training on tracheal intubation procedure safety in the pediatric intensive care. Anesthesiology 2010;113(1):214‐23. [DOI: 10.1097/ALN.0b013e3181e19bf2; PUBMED: 20526179]

O'Donnell 2006

O'Donnell CP, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006;117(1):e16‐21. [DOI: 10.1542/peds.2005‐0901; PUBMED: 16396845]

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Jump to:

Kamlin 2013

Methods

Objective: to determine whether paediatric trainees were more successful at neonatal orotracheal intubation when a stylet was used

Study design: unblinded randomised controlled trial

Object of randomisation: first intubation attempt; for infants who had more than 1 episode of intubation during admission, each episode of intubation was randomised and was treated as an independent event

Recruitment: For emergency first intubations in the delivery room or within 24 hours of birth, a waiver of consent was used to enrol infants, and retrospective consent was obtained from parents as soon as possible after the intubation attempt. Infants who were intubated in the neonatal intensive care unit (NICU) after the first day were eligible if written parental consent had been obtained. Permission from parents was also sought to randomise future intubations

Allocation: randomly assigned

Total number of intubations: 713

Number of infants randomised: 232

Number of intubations randomised: 304

Method of analysis: Data are presented as means (standard deviations) for normally distributed continuous variables and medians (interquartile ranges) when the distribution is skewed. Clinical characteristics and outcome variables were analysed by using Student's t test for parametric comparisons, the Mann‐Whitney U test for non‐parametric comparisons of continuous variables, and X2 for categorical variables. P values were 2‐sided, and P values < 0.05 were considered statistically significant

Follow‐up: No participants had tracheal or oesophageal perforation. Rates of blood‐stained aspirates within the first 24 hours were included as a secondary outcome. No information on follow‐up was provided beyond this

Participants

Country: Australia

Clinical setting: delivery room and neonatal intensive care unit

Inclusion criteria: Eligible participants were newborn infants in the delivery room or NICU requiring endotracheal intubation

Exclusion criteria: Infants who were intubated for suctioning of meconium from the trachea were not eligible owing to the difficulty of confirming correct endotracheal tube (ET) placement

Age (weeks): mean gestational age of participants: stylet = 28.5 (standard deviation (SD) 5.0); no stylet = 28.7 (SD 5.2)

Birth weight (grams): stylet = 925 (interquartile ratio (IQR) 689 to 1473); no stylet = 862 (IQR 714 to 1586)

Gender: male infants: stylet = 86 (SD 58); no stylet = 92 (SD 60)

Ethnicity: not stated

Site of intubation: delivery room (DR): stylet n = 72; no stylet n = 74; NICU: stylet n = 77; NICU n = 79

Seniority of operator: fellow: stylet 33 (SD 11); no stylet 41 (SD 14); resident: stylet 116 (SD 38); no stylet 112 (SD 37)

Interventions

Intervention arm: A stylet was used as an aid during orotracheal intubation of the newborn infant

Control arm: orotracheal intubation of the newborn infant without the use of a stylet

Outcomes

Primary outcome

Intubation success rates on first attempt with use of stylet vs non‐use as indicated by detection of exhaled carbon dioxide

Secondary outcomes

• Duration of intubation attempt

• Changes in heart rate and oxygen saturation from baseline

• Presence of blood‐stained secretions after the procedure

Notes

Trial registration: Australian and New Zealand Clinical Trials Register (ACTR identifier: 12607000186459)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

Intervention was assigned by random sequence. Randomisation occurred in blocks of variable size stratified by site of intubation (delivery room (DR) or neonatal intensive care (NICU))

Allocation concealment (selection bias)

Low risk

Upcoming allocations were concealed from those involved in enrolment of the trial. Sequentially numbered sealed opaque envelopes contained computer‐generated treatment groups, which the neonatal fellow on duty carried to the DR unopened to randomise the next eligible infant in the DR. Infants in the NICU were identifiable by a study label on the incubator

Blinding of participants and personnel (performance bias)
All outcomes

High risk

Study was unblinded with regards to intervention allocation. Owing to the nature of the intervention, it was not possible to mask hospital staff or parents/guardians of the infant to the allocation status

Blinding of outcome assessment (detection bias)
All outcomes

High risk

Assessors of outcomes were unblinded to intervention allocation

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Reasons for excluded infants (n = 481): intubated for meconium/before fellow arrived (n = 102); forgot/team thought ineligible (n = 264); other reasons, e.g. emergencies, twins, nasal intubation, consultant intubation (n = 115). Eligible intubations that were excluded were accounted for and explained (n = 21). These were consented for prospective NICU intubations, but the team was unaware or had insufficient time owing to emergency intubation required

Selective reporting (reporting bias)

Low risk

Study protocol is available, and all prespecified primary and secondary outcomes have been reported in the prespecified way

Characteristics of excluded studies [ordered by study ID]

Jump to:

Study

Reason for exclusion

Fisher 1997

Prospective observational study

MacNab 1998

Comparison of lighted vs regular stylet ‐ not of stylet vs no stylet

Shukry 2005

Non‐experimental study: case report

Yamashita 2015

Randomised controlled trial comparing transillumination method vs main‐stem method

Data and analyses

Open in table viewer
Comparison 1. First intubation attempt success rate with use of stylet vs non‐use of stylet

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 First intubation attempt success rate Show forest plot

1

302

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.88, 1.32]

Analysis 1.1

Comparison 1 First intubation attempt success rate with use of stylet vs non‐use of stylet, Outcome 1 First intubation attempt success rate.

Comparison 1 First intubation attempt success rate with use of stylet vs non‐use of stylet, Outcome 1 First intubation attempt success rate.

Open in table viewer
Comparison 2. Intubation success: professional category

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fellow: first intubation attempt success rate Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.69, 1.29]

Analysis 2.1

Comparison 2 Intubation success: professional category, Outcome 1 Fellow: first intubation attempt success rate.

Comparison 2 Intubation success: professional category, Outcome 1 Fellow: first intubation attempt success rate.

2 Resident: first intubation attempt success rate Show forest plot

1

228

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.90, 1.52]

Analysis 2.2

Comparison 2 Intubation success: professional category, Outcome 2 Resident: first intubation attempt success rate.

Comparison 2 Intubation success: professional category, Outcome 2 Resident: first intubation attempt success rate.

Open in table viewer
Comparison 3. Intubation success: use of premedication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intubations without premedication given to the infant Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.72, 1.32]

Analysis 3.1

Comparison 3 Intubation success: use of premedication, Outcome 1 Intubations without premedication given to the infant.

Comparison 3 Intubation success: use of premedication, Outcome 1 Intubations without premedication given to the infant.

2 Intubations following premedication given to the infant Show forest plot

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.89, 1.55]

Analysis 3.2

Comparison 3 Intubation success: use of premedication, Outcome 2 Intubations following premedication given to the infant.

Comparison 3 Intubation success: use of premedication, Outcome 2 Intubations following premedication given to the infant.

Open in table viewer
Comparison 4. Intubation success: timing of intubation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intubations just after birth in the delivery room: first intubation attempt success rate Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.72, 1.32]

Analysis 4.1

Comparison 4 Intubation success: timing of intubation, Outcome 1 Intubations just after birth in the delivery room: first intubation attempt success rate.

Comparison 4 Intubation success: timing of intubation, Outcome 1 Intubations just after birth in the delivery room: first intubation attempt success rate.

2 intubations following admission to NICU: first intubation attempt success rate Show forest plot

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.89, 1.55]

Analysis 4.2

Comparison 4 Intubation success: timing of intubation, Outcome 2 intubations following admission to NICU: first intubation attempt success rate.

Comparison 4 Intubation success: timing of intubation, Outcome 2 intubations following admission to NICU: first intubation attempt success rate.

Open in table viewer
Comparison 5. Intubation success: weight at intubation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight < 1000 grams Show forest plot

1

152

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.67, 1.18]

Analysis 5.1

Comparison 5 Intubation success: weight at intubation, Outcome 1 Weight < 1000 grams.

Comparison 5 Intubation success: weight at intubation, Outcome 1 Weight < 1000 grams.

2 Weight ≥ 1000 grams Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.97, 1.79]

Analysis 5.2

Comparison 5 Intubation success: weight at intubation, Outcome 2 Weight ≥ 1000 grams.

Comparison 5 Intubation success: weight at intubation, Outcome 2 Weight ≥ 1000 grams.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 First intubation attempt success rate with use of stylet versus non‐use of stylet, outcome: 1.1 First intubation attempt success rate.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 First intubation attempt success rate with use of stylet versus non‐use of stylet, outcome: 1.1 First intubation attempt success rate.

Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.1 Fellow: first intubation attempt success rate.
Figures and Tables -
Figure 5

Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.1 Fellow: first intubation attempt success rate.

Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.2 Resident: first intubation attempt success rate.
Figures and Tables -
Figure 6

Forest plot of comparison: 2 Intubation success: Professional category, outcome: 2.2 Resident: first intubation attempt success rate.

Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.1 Intubations without premedication given to the infant.
Figures and Tables -
Figure 7

Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.1 Intubations without premedication given to the infant.

Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.2 Intubations following premedication given to the infant.
Figures and Tables -
Figure 8

Forest plot of comparison: 3 Intubation success: use of premedication, outcome: 3.2 Intubations following premedication given to the infant.

Comparison 1 First intubation attempt success rate with use of stylet vs non‐use of stylet, Outcome 1 First intubation attempt success rate.
Figures and Tables -
Analysis 1.1

Comparison 1 First intubation attempt success rate with use of stylet vs non‐use of stylet, Outcome 1 First intubation attempt success rate.

Comparison 2 Intubation success: professional category, Outcome 1 Fellow: first intubation attempt success rate.
Figures and Tables -
Analysis 2.1

Comparison 2 Intubation success: professional category, Outcome 1 Fellow: first intubation attempt success rate.

Comparison 2 Intubation success: professional category, Outcome 2 Resident: first intubation attempt success rate.
Figures and Tables -
Analysis 2.2

Comparison 2 Intubation success: professional category, Outcome 2 Resident: first intubation attempt success rate.

Comparison 3 Intubation success: use of premedication, Outcome 1 Intubations without premedication given to the infant.
Figures and Tables -
Analysis 3.1

Comparison 3 Intubation success: use of premedication, Outcome 1 Intubations without premedication given to the infant.

Comparison 3 Intubation success: use of premedication, Outcome 2 Intubations following premedication given to the infant.
Figures and Tables -
Analysis 3.2

Comparison 3 Intubation success: use of premedication, Outcome 2 Intubations following premedication given to the infant.

Comparison 4 Intubation success: timing of intubation, Outcome 1 Intubations just after birth in the delivery room: first intubation attempt success rate.
Figures and Tables -
Analysis 4.1

Comparison 4 Intubation success: timing of intubation, Outcome 1 Intubations just after birth in the delivery room: first intubation attempt success rate.

Comparison 4 Intubation success: timing of intubation, Outcome 2 intubations following admission to NICU: first intubation attempt success rate.
Figures and Tables -
Analysis 4.2

Comparison 4 Intubation success: timing of intubation, Outcome 2 intubations following admission to NICU: first intubation attempt success rate.

Comparison 5 Intubation success: weight at intubation, Outcome 1 Weight < 1000 grams.
Figures and Tables -
Analysis 5.1

Comparison 5 Intubation success: weight at intubation, Outcome 1 Weight < 1000 grams.

Comparison 5 Intubation success: weight at intubation, Outcome 2 Weight ≥ 1000 grams.
Figures and Tables -
Analysis 5.2

Comparison 5 Intubation success: weight at intubation, Outcome 2 Weight ≥ 1000 grams.

Stylet compared with no stylet for neonatal intubation

Patient or population: neonates requiring endotracheal intubation

Settings: neonatal intensive care unit or delivery room or theatre

Intervention: a stylet inserted into the endotracheal tube

Comparison: no stylet inserted into the endotracheal tube

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of intubations
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Stylet

First intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

529 per 1000

570 per 1000
(466 to 698)

RR 1.08
(0.88 to 1.32)

302
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Gestational age of the infant

no data

no data

no data

no data

absence of evidence

Professional category of the intubator ‐ fellow: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

707 per 1000

667 per 1000
(488 to 548)

RR 0.94
(0.69 to 1.29)

74
(1)

⊕⊕⊝⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Professional category of the intubator ‐ resident: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

464 per 1000

543 per 1000
(418 to 705)

RR 1.17
(0.90 to 1.52)

228
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Level of experience of the intubator

no data

no data

no data

no data

absence of evidence

Premedication given ‐ no premedication given: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

540 per 1000

528 per 1000
(389 to 713)

RR 0.98
(0.72 to 1.32)

146
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Premedication given ‐ no premedication given: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

519 per 1000

610 per 1000
(462 to 804)

RR 1.18
(0.89 to 1.55)

156
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Timing of intubation ‐ just after birth in the delivery room: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

540 per 1000

528 per 1000
(389 to 713)

RR 0.98
(0.72 to 1.32)

146
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Timing of intubation ‐ following admission to NICU: first intubation attempt success rate

(outcome achieved at time of intubation attempt and not followed up)

519 per 1000

610 per 1000
(462 to 804)

RR 1.18
(0.89 to 1.55)

156
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

Type of stylet

no data

no data

no data

no data

absence of evidence

Weight < 1000 g

(outcome achieved at time of intubation attempt and not followed up)

597 per 1000

533 per 1000
(400 to 704)

RR 0.89
(0.67 to 1.18)

152
(1)

⊕⊕⊕⊝a,b
low

Unblinded trial with no blinded outcome assessment

Single study

*The basis for the assumed risk (e.g. median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on assumed risk in the comparison group and relative effect of the intervention (and its 95% CI)
CI: confidence interval; RR: risk ratio

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aHigh risk of detection bias (due to lack of blinding of caregivers and outcome assessors)

bSerious imprecision (due to small number of events and small sample sizes; 95% CIs include null effects)

Figures and Tables -
Comparison 1. First intubation attempt success rate with use of stylet vs non‐use of stylet

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 First intubation attempt success rate Show forest plot

1

302

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.88, 1.32]

Figures and Tables -
Comparison 1. First intubation attempt success rate with use of stylet vs non‐use of stylet
Comparison 2. Intubation success: professional category

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Fellow: first intubation attempt success rate Show forest plot

1

74

Risk Ratio (M‐H, Fixed, 95% CI)

0.94 [0.69, 1.29]

2 Resident: first intubation attempt success rate Show forest plot

1

228

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.90, 1.52]

Figures and Tables -
Comparison 2. Intubation success: professional category
Comparison 3. Intubation success: use of premedication

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intubations without premedication given to the infant Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.72, 1.32]

2 Intubations following premedication given to the infant Show forest plot

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.89, 1.55]

Figures and Tables -
Comparison 3. Intubation success: use of premedication
Comparison 4. Intubation success: timing of intubation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Intubations just after birth in the delivery room: first intubation attempt success rate Show forest plot

1

146

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.72, 1.32]

2 intubations following admission to NICU: first intubation attempt success rate Show forest plot

1

156

Risk Ratio (M‐H, Fixed, 95% CI)

1.18 [0.89, 1.55]

Figures and Tables -
Comparison 4. Intubation success: timing of intubation
Comparison 5. Intubation success: weight at intubation

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Weight < 1000 grams Show forest plot

1

152

Risk Ratio (M‐H, Fixed, 95% CI)

0.89 [0.67, 1.18]

2 Weight ≥ 1000 grams Show forest plot

1

150

Risk Ratio (M‐H, Fixed, 95% CI)

1.32 [0.97, 1.79]

Figures and Tables -
Comparison 5. Intubation success: weight at intubation