Neonatal endotracheal intubation: development of a comprehensive educational program for procedural skills

Background: Acquiring skills for neonatal endotracheal intubation (ETI) has become difficult for trainees due to decreased opportunities following the increased use of non-invasive respiratory support. Recent studies report very low rates of successful first-attempt ETI in neonates despite current educational strategies. Hence, novel approaches for coaching the trainees to become procedurally competent are urgently required. Methods: A comprehensive literature review of PubMed, Embase, Emcare, CINAHL, and Cochrane Library databases was conducted in January 2025 to identify evidence-based strategies to improve neonatal ETI skills. A multidisciplinary approach was taken for integrating stress-management skills in the educational program. Results: Video-laryngoscopy aided coaching, Just-in-time training, frequent practice on mannequins, rapid cycle deliberate practice, mental skills training, and deep-slow breathing were identified as appropriate strategies for inclusion in the educational program. Based on the principles of micro-credentialing, a comprehensive educational program was developed. Conclusions: Our innovative educational program focuses on enhancing procedural skills for neonatal ETIs and reducing acute stress response in trainees while performing the procedure. Well-designed studies are needed to evaluate the impact of the program on patient outcomes and trainee wellbeing. Whilst primarily aimed at trainees, even senior fellows, consultants and nursing staff can use it to maintain their skills. Impact: Our program facilitates coaching of trainees in neonatal endotracheal intubation skills. It provides feasible solutions to attenuate stress while performing the procedure. Whilst primarily aimed at trainees, even senior clinicians can use it. The program has the potential to improve patient safety and trainee wellbeing. It can be adopted for other high-acuity low-occurrence (HALO) clinical procedures.