Acute Management of the Neonatal Airway

Background and Objectives: Emerging technologies, such as respiratory function monitors (RFMs) and video laryngoscopes, have the potential to improve the teaching of newborn face mask ventilation and intubation. In this thesis, I aimed to explore how these advancements can improve the training and practice of these critical neonatal procedures. The specific objectives were to review the evidence on teaching these skills, assess resuscitation practices in Ireland, and evaluate the impact of RFMs on ventilation effectiveness. Additionally, I aimed to determine how RFMs could be integrated into mask ventilation training and assess the application of the VL technique as it becomes increasingly prevalent in neonatal care. Methods: This research included clinicians involved in newborn resuscitation and infants undergoing intubation with VL. The methods included several preparatory studies: a systematic literature review of the evidence for teaching newborn face mask ventilation and intubation, a nationwide survey of neonatal centres in Ireland, and a randomised, crossover manikin study comparing two RFMs. Subsequently, two further studies were conducted: a multicentre, before-and-after manikin study evaluating the effectiveness of a standardised training intervention on face mask ventilation, and a prospective, observational study assessing synchronised video recordings of laryngoscope views and the external environment. Results: RFM feedback enhances mask ventilation training, but further research is needed to refine teaching methods. While VL has shown promise in neonatal intubation training, most studies have focused on the direct laryngoscopy (DL) technique. There was considerable variability in newborn resuscitation training, equipment, and governance across Ireland. Although RFM feedback with a simple visual display improved ventilation, challenges remained in addressing ineffective ventilations. A standardised training intervention using an RFM with simple visual feedback significantly reduced face mask leak. Neonatal intubation using VL frequently deviated from current resuscitation guidelines, with unclear verbal instructions from supervisors. Conclusions: There is a need for standardised national protocols and training resources. While RFM feedback with a simple display enhances mask ventilation, additional guidance may be required to help operators correct ineffective ventilations. A standardised training intervention on face mask ventilation improves short-term skills and may be replicable beyond research settings. Updated resuscitation guidelines and improved communication are essential for VL intubation, and further investigation into effective verbal cues is warranted.