Optimizing Tracheal Intubation Outcomes and Neonatal Safety

This observational study examines tracheal intubation outcomes in premature and sick newborns admitted to the neonatal intensive care unit (NICU). Tracheal intubation — inserting a breathing tube into a newborn's airway — is one of the highest-risk procedures performed in the NICU, frequently associated with oxygen desaturation, bradycardia (slow heart rate), and, in worst cases, cardiac arrest. The study systematically tracks clinical data around each intubation to identify factors associated with adverse events and areas for quality improvement. All infants undergoing tracheal intubation in the NICU are eligible. The only exclusion is endotracheal tube exchanges, which represent a different procedure with distinct risks and techniques. Despite being performed thousands of times daily in NICUs worldwide, tracheal intubation in newborns remains poorly standardized, and practices vary enormously between institutions. Adverse events during intubation are alarmingly common — some studies report serious events in over 20% of procedures. By carefully documenting the circumstances, techniques, and outcomes of each intubation attempt, this study will generate the evidence base needed to develop standardized protocols, inform training curricula, and ultimately make one of neonatology's most critical procedures safer for the most vulnerable patients.