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 cmH₂O (61%), pH < 7.2 (55%), pCO₂ > 70 mmHg (48%), FiO₂ > 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, FiO₂, 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.