Ellen de Kort

164 Chapter 9 Due to factors such as an increased presence of advanced practice providers in the NICU and an increased use of non-invasive ventilation strategies, opportunities for pediatric residents to perform neonatal intubation are limited. 1-8,96,100 Nowadays, pediatric residents are graduating without having achieved the competency to intubate a neonate. 7,101 This certainly can be a problem, since pediatricians involved in the care of newborns will be confronted with a neonate requiring endotracheal intubation at some point during their further career. Ways to improve neonatal intubation skills of pediatric residents lay in structured simulation training programs targeting on gaining the skills of neonatal intubation before performing the procedure in real patients. 11 Also, the use of a video laryngoscope, which gives the instructor a view of the upper airway, making it possible to provide clear guidance, has been shown to significantly increase the first attempt success rate of pediatric residents. 102,103 READY TO TACK – Towards intubation by experienced health care providers Recommendations for clinical practice • In each intubation procedure the airway provider should be chosen with careful consideration. Gestational age, weight, the indication for endotracheal intubation and the condition of the patient should be taken into account when deciding who will perform the intubation. • Urgent and emergency intubations, and intubations in small or unstable patients should be performed by an airway provider skilled in neonatal intubation. • Efforts to provide adequate intubating experience for pediatric residents should focus on the larger and more stable neonatal population and on simulation training. • The use of a video laryngoscope can improve the first attempt success rates of inexperienced airway providers and should be considered.