Identifying the Most Accurate Method for Predicting the Safe Depth of Orally Placed Neonatal Endotracheal Tubes (ETT).

Placing artificial airways in infants is often performed under emergent life-saving
conditions, which necessitates a procedure that is both accurate and efficient. Intubations
of the newborn are often necessary before an accurate weight can be reported and estimations
are often inaccurate. The current national standard uses body weight to predict the
appropriate tube depth yet this approach tends to place the tube too deep for the smallest
and most vulnerable neonate; and placement accuracy of any size infant is only 50-70%. The
consequence of malpositioned ETTs resulting from poor oxygenation, lung hyperinflation,
pneumothoraces and death has been suggested to cost $20 to $54 million annually.

The morbidity and the financial impact suggest an optimal and accurate approach to place ETT
in neonates has not been identified. Other methods to estimate the proper depth of the
orotracheal tube have shown promise yet no comparison studies have been performed.
Identifying the most accurate method to safely place neonatal orotracheal tubes will improve
placement precision and reduce adverse events and their associated costs.

Hypothesis

Compared to weight, sternal to xyphoid length and shoulder to elbow length, the nasal to
tragus length will become the most accurate method for predicting the safe depth of orally
placed neonatal endotracheal tubes.