Video vs. traditional laryngoscopy for tracheal intubation at birth or in the neonatal unit: A systematic review and meta-analysis
Why this work is in the frame
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Bibliographic record
Abstract
• Previous evidence considered video laryngoscopy use by neonatal or anesthetic clinicians in delivery rooms, neonatal units or operating rooms. • Moderate certainty evidence that video laryngoscopy increases intubation success for neonatal staff in the delivery room or neonatal unit. • High certainty evidence that video laryngoscopy increases first attempt intubation success for neonatal staff in delivery room or neonatal unit. • Adverse events with video laryngoscopy were infrequent and clinical benefit or harm compared to traditional laryngoscopy could not be excluded. • Video laryngoscopy may be a valuable tool to assist neonatal intubation, particularly when training inexperienced neonatal clinicians. Videolaryngoscopy may increase neonatal intubation success when used by neonatologists and anesthesiologists. It is not known if this is true for intubations by neonatal clinicians only in neonatal units or on delivery suites. To critically appraise evidence on the success of tracheal intubation with video laryngoscopy compared to traditional laryngoscopy in infants at birth or in a neonatal unit. Systematic review of studies identified by MEDLINE, Embase, Cochrane Library, CINAHL and Clinical Trial Databases searched from inception to August 22, 2024, without language restrictions. Studies that addressed the PICOST question: In infants receiving tracheal intubation at birth or on a neonatal unit (population), does video laryngoscopy (intervention), compared with traditional laryngoscopy (comparator), improve success (outcome)? Studies that included preoperative intubation or studies of video laryngoscopy use specifically for difficult airways were excluded. Risk of bias was assessed using Cochrane Risk of Bias 2 or ROBINS-I, meta-analysis using RevMan v. 5.4.1, and certainty of evidence using GRADEPro. Studied outcomes were successful tracheal intubation, successful intubation at first attempt, in-hospital mortality, adverse events attributed to laryngoscopy and perception of the intubating clinician. Of 1261 records screened, six randomized controlled trials reporting 817 infants receiving 862 tracheal intubations were included. Success of intubation was higher overall with video laryngoscopy [ relative risk 1.43; 95% confidence interval 1.15–1.77; p -value = 0.001; moderate certainty evidence] and at first attempt [relative risk 1.56; 95% confidence interval 1.33–1.84; p -value <0.001; high certainty evidence]. For mortality or adverse outcomes including airway trauma, esophageal intubation, desaturation <80%, bradycardia to either <60 or <100 beats/minute, clinical benefit or harm could not be excluded. Two randomised controlled trials reported intubator perceptions, but results could not be combined. Most of the first attempts in the randomised controlled trials were by inexperienced intubators. Four observational studies (3,289 infants; 3,342 intubations) showed increased success at first attempt with video laryngoscopy [relative risk 1.78; 95% confidence interval 1.16–2.74; p -value <0.001; very low certainty evidence]. For infants in the delivery room or neonatal unit, use of video laryngoscopy improved overall and first attempt intubation success. Prospero Registration: CRD42023467940.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it