# Impact of attending neonatologist presence on neonatal intubation success and adverse events: a cohort study

## TL;DR

This study examines whether having an experienced neonatologist present affects the success of neonatal intubation and related complications.

## Contribution

The study reveals that attending neonatologist presence is linked to lower first-attempt intubation success after adjusting for confounding factors.

## Key findings

- Univariate analysis showed higher first-attempt success with attending presence.
- Multivariate analysis found lower success odds with attending presence.
- Attendings were present in 66% of intubations by junior operators.

## Abstract

To evaluate the effect of attending neonatologist presence on first attempt neonatal intubation success and adverse events.

Retrospective review of National Emergency Airway Registry for Neonates (NEAR4NEOS) intubations October 2014 - December 2022. Univariate and multivariate analyses were performed to estimate associations between attending presence and outcomes.

Among 12,652 intubation encounters, attendings were present for 8,391 (66%) intubations by more junior operators. On univariate analysis, attending presence was associated with first attempt intubation success (OR 1.11, 95% CI 1.04–1.2). However, on multivariate analysis, attending presence was associated with lower first attempt success (aOR 0.78, 95% CI 0.70–0.86) and intubation requiring ≥ 3 intubation attempts (aOR 1.39, 95% CI 1.21–1.60).

After adjustment, attending presence was associated with lower odds of first attempt intubation success. Reasons for this may include appropriate anticipation of high-risk intubations, altered team dynamics or unmeasured confounding biases.