Objective To determine the factors associated with second attempt success and the risk of adverse events following a failed first attempt at neonatal tracheal intubation. Design Retrospective analysis of prospectively collected data on intubations performed in the neonatal intensive care unit (NICU) and delivery room from the National Emergency Airway Registry for Neonates (NEAR4NEOS). Setting Eighteen academic NICUs in NEAR4NEOS. Patients Neonates requiring two or more attempts at intubation between October 2014 and December 2021. Main outcome measures The primary outcome was successful intubation on the second attempt, with severe tracheal intubation-associated events (TIAEs) or severe desaturation (≥20% decline in oxygen saturation) being secondary outcomes. Multivariate regression examined the associations between these outcomes and patient characteristics and changes in intubation practice. Results 5805 of 13 126 (44%) encounters required two or more intubation attempts, with 3156 (54%) successful on the second attempt. Second attempt success was more likely with changes in any of the following: intubator (OR 1.80, 95% CI 1.56 to 2.07), stylet use (OR 1.65, 95% CI 1.36 to 2.01) or endotracheal tube (ETT) size (OR 2.11, 95% CI 1.74 to 2.56). Changes in stylet use were associated with a reduced chance of severe desaturation (OR 0.74, 95% CI 0.61 to 0.90), but changes in intubator, laryngoscope type or ETT size were not; no changes in intubator or equipment were associated with severe TIAEs. Conclusions Successful neonatal intubation on a second attempt was more likely with a change in intubator, stylet use or ETT size. Data are available upon reasonable request. Individual subject data collected during the study and statistical analysis will be available beginning at 12 months and ending 5 years after article publication to researchers who provide a methodologically sound proposal with approval by the NEAR4NEOS Manuscript Oversight Committee. Data will be available for analysis to achieve aims in the approved proposal. Proposals should be directed to buffmanH@chop.edu; to gain access, data requestors will need to sign a data access agreement approved by the Children’s Hospital of Philadelphia.

中文翻译：

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第一次尝试失败后影响新生儿插管第二次成功的因素：国家新生儿紧急气道登记处的报告

目的 确定与第二次尝试成功相关的因素以及新生儿气管插管首次尝试失败后发生不良事件的风险。设计 对国家新生儿紧急气道登记处 (NEAR4NEOS) 前瞻性收集的新生儿重症监护病房 (NICU) 和产房插管数据进行回顾性分析。在 NEAR4NEOS 中设置 18 个学术 NICU。患者 2014 年 10 月至 2021 年 12 月期间需要两次或多次尝试插管的新生儿。 主要结局指标 主要结局是第二次尝试插管成功，伴有严重气管插管相关事件 (TIAE) 或严重氧饱和度下降（氧下降≥20%）饱和度）是次要结果。多变量回归检查了这些结果与患者特征和插管实践变化之间的关联。结果 13 126 例患者中，有 5805 例 (44%) 需要两次或多次插管尝试，其中 3156 例 (54%) 第二次尝试成功。如果以下任何一项发生变化，第二次尝试成功的可能性更大：插管器（OR 1.80，95% CI 1.56 至 2.07）、管心针使用（OR 1.65，95% CI 1.36 至 2.01）或气管插管 (ETT) 尺寸（OR 2.11） ，95% CI 1.74 至 2.56）。管心针使用的变化与严重饱和度降低的可能性降低相关（OR 0.74，95% CI 0.61 至 0.90），但插管器、喉镜类型或 ETT 尺寸的变化则不然；插管器或设备的变化与严重 TIAE 无关。结论 通过改变插管器、管心针使用或 ETT 尺寸，新生儿第二次插管成功的可能性更大。数据可根据合理要求提供。研究和统计分析期间收集的个体受试者数据将从文章发表后 12 个月开始，到文章发表后 5 年后提供给研究人员，这些研究人员提供了方法上合理的提案，并得到了 NEAR4NEOS 手稿监督委员会的批准。数据将可用于分析，以实现批准提案中的目标。提案应发送至 buffmanH@chop.edu；要获得访问权限，数据请求者需要签署费城儿童医院批准的数据访问协议。