Key Messages
Videolaryngoscopy may increase the success of placing a breathing tube on the first attempt, and may result in slightly fewer tries by a care provider to place the breathing tube in sick newborn babies, but it does not reduce the amount of time it takes to place the breathing tube.
Videolaryngoscopy likely results in slightly less injury to the newborn baby's airway while the breathing tube is being placed.
We need better studies to understand the role of videolaryngoscopy in different practice areas and with different care providers doing the placement.
What is the problem?
One in 100 newborn babies may need a breathing tube placed in their mouth or nose to keep them alive when they have difficulty breathing. Placing a breathing tube using direct laryngoscopy (without video assistance) may be challenging in newborns because their mouths and airways are small, and not all care providers are experienced.
What is videolaryngoscopy?
Seeing the airway by a video while placing the breathing tube is called videolaryngoscopy. This may make it easier and safer to place the breathing tube. This also may help trainees when they are learning this life-saving skill.
What did we want to find out?
We wanted to find out if using videolaryngoscopy increased the success and safety of the placement of a breathing tube compared to the direct laryngoscopy technique, in babies who were 0 to 28 days old.
What did we do?
We searched for studies that were trying to find out whether video devices were better than the standard approach without video assistance (direct laryngoscopy) for placing breathing tubes in babies. The studies could measure time, the number of attempts, the success rate of the first attempt to place the breathing tube, or side effects.
We compared and summarized the results of the studies, and rated our confidence in the evidence, based on factors such as study methods and sizes.
What did we find?
We found eight eligible studies, which included 759 intubation attempts in newborn babies. They reported time, the number of attempts, the success rate of the first attempt to place the breathing tube, and side effects. In summary:
Videolaryngoscopy may increase the success of placing a breathing tube on the first attempt, and may result in slightly fewer tries by a care provider to place the breathing tube in sick newborn babies, but does not reduce the amount of time it takes to place the breathing tube.
Videolaryngoscopy may have little or no effect on how many babies have episodes of low oxygen or low heart rate (or both) while the breathing tube is being placed, but the evidence is very uncertain. Videolaryngoscopy may result in little or no difference in the lowest levels of oxygen while the breathing tube is being placed.
Videolaryngoscopy likely results in slightly less injury to the newborn baby’s airway while the breathing tube is being placed.
There were no data available on other adverse effects while the breathing tube is being placed.
What are the limitations of the evidence?
We found that the included studies were small, we were unable to assess the risk of bias in some, and the study results varied. The care providers who placed the breathing tube knew which device was being used. This decreases our confidence in the results of the review, and the results of further research could differ from the results of this review.
Funding and equipment support was provided in some of the included studies. In some cases, funding sources and declarations of interest were not stated.
How up to date is this evidence?
The evidence is up to date to November 2022.
