# The Effect of Endotracheal Tube (ETT) Tip Position on Lung Aeration in Term and Preterm Neonates: A Comparative Analysis

## TL;DR

This study examines how the position of an endotracheal tube affects lung aeration in term and preterm neonates, finding that proper placement improves lung aeration in term infants more than in preterm ones.

## Contribution

The study identifies a significant link between ETT tip position and lung aeration in term neonates, highlighting gestational age as a factor in respiratory care.

## Key findings

- Term neonates with ETT tip at T1-T2 had significantly higher optimal lung aeration (72.2%) compared to T3-T4 (27.8%).
- Preterm neonates showed no significant difference in lung aeration based on ETT tip position.
- Optimal lung aeration was observed in 83.2% of the 149 neonates studied.

## Abstract

Background: Proper endotracheal tube (ETT) position is crucial for neonatal lung aeration. The purpose of this study is to determine the effect of ETT tip position on lung aeration in term and preterm infants.

Methods: This retrospective chart study involved neonates who were admitted to the Neonatal Intensive Care Unit (NICU) and intubated, and it was carried out from February 2023 to July 2023 at the Sindh Institute of Child Health and Neonatology. ETT tip position was analyzed, and chest x-rays (CXRs) were obtained within four hours of intubation. On a CXR, lung expansion evident to eight or eight and a half ribs was considered adequate lung inflation/aeration; fewer than eight ribs were considered poor lung inflation/aeration. To ascertain relationships between ETT tip location and lung aeration, data were examined using the chi-square test in SPSS version 26 (IBM Corp., Armonk, NY).

Results: Out of 149 neonates, 105 (70.5%) were preterm and 44 (29.5%) were term. Optimal lung aeration was observed in 124 neonates (83.2%). The ETT tip was positioned at T1-T2 in 86 neonates (57.7%) and at T3-T4 in 63 neonates (42.3%). For term neonates, those with the ETT tip at T1-T2 exhibited significantly higher rates of optimal lung aeration (72.2%) compared to those with the tip at T3-T4 (27.8%, p = 0.019). Conversely, no significant difference in lung aeration was noted among preterm neonates based on ETT position (p = 0.745).

Conclusions: In conclusion, our study found a significant association between ETT tip positioning at T1-T2 and optimal lung aeration in term neonates. This suggests that precise ETT placement may play an important role in achieving better lung aeration in term infants, while slight positional deviations may be less impactful for lung aeration in preterm neonates. These findings may guide NICU protocols to consider gestational age when tailoring ventilation strategies, emphasizing the importance of anatomical and physiological differences in neonatal respiratory care.