Scolaris Content Display Scolaris Content Display

Study flow diagram.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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]

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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]

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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]

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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]

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Comparison 5. Intubation success: weight at intubation