A survey on criteria for intubation in moderate to late preterm infants with respiratory distress

Background Majority of preterm infants do well with continuous positive airway pressure (CPAP) as the sole respiratory management; but some require endotracheal intubation and surfactant administration. While intubation is needed predominantly in extremely preterm infants (<28 weeks); some of the more mature preterm infants also require it. Currently, there are no clear guidelines regarding indications for endotracheal intubation in such infants. Aims To understand the current practice regarding "criteria for intubation" in moderate to late preterm infants with respiratory distress. Methods A survey of neonatologists in Australia New Zealand Neonatal Network (ANZNN) was conducted between April and June 2019. Results At least one neonatologist each from 29 of the 30 tertiary ANZNN Neonatal Intensive Care Units (NICUs) responded to the survey. In total, 118/200 (59%) neonatologists responded. The most common criteria for intubation were CPAP = 8 cmH(2)O (61%), pH < 7.2 (55%), pCO(2) > 70 mmHg (48%), FiO(2) > 40% (40%), chest retractions (48%), more than two episodes of apnea requiring intervention (54%), and chest X-ray (CXR) showing moderate-severe hyaline membrane disease (HMD, 49%). Conclusion While there were variations in practice, nearly 50% of the neonatologists shared a common threshold with regards to the CPAP level, FiO(2), blood gas parameters, and clinical and radiological findings. The results of this survey will help in designing future randomized controlled trials (RCTs) on this subject.