{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:15:46Z","timestamp":1788221746936,"version":"build-2803163510"},"reference-count":25,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND AND OBJECTIVES<\/jats:title>\n                    <jats:p>Neonatal tracheal intubation is a high-risk procedure, and multiple attempts are associated with adverse events. At our tertiary neonatal intensive care unit, the baseline first-attempt success rate was 45%, which we aimed to increase to over 55% through a quality improvement (QI) initiative.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A multidisciplinary team conducted a QI project using the define-measure-analyze-improve-control framework. Root cause analysis identified poor glottic visualization and patient instability as primary drivers of failure. Plan-do-study-act cycles were carried out (April 2023\u2013July 2024), followed by a sustainability phase (August 2024\u2013May 2025). Key interventions included the phased implementation of video laryngoscopy (VL) as the primary intubation device and the standardization of oxygenation during laryngoscopy using nasal high flow. First-attempt success was tracked using statistical process control, and bimonthly VL use was monitored as a process measure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 642 intubations were analyzed. By control chart analysis, the first-attempt success rate increased from a baseline of 45% to a sustained process mean of 61% during the intervention and sustainability phases. VL use increased from 0% at baseline to 70% to 90% during the sustainability phase. Success rates improved across all clinician types and locations. Notably, first-attempt success in infants weighing less than 1000\u00a0g increased from 38% at baseline to 62% during the intervention phase.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION<\/jats:title>\n                    <jats:p>A systematic QI initiative focused on VL and standardized oxygenation improved and sustained neonatal intubation success rates, exceeding the project aim. The maintenance of high-success rates confirms the durability of these safety improvements.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1542\/peds.2025-074216","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:02:23Z","timestamp":1787270543000},"source":"Crossref","is-referenced-by-count":0,"title":["Improving First-Attempt Success Rate During Neonatal Intubation in a Tertiary NICU"],"prefix":"10.1542","volume":"158","author":[{"given":"Mark W.","family":"Kaczor","sequence":"first","affiliation":[{"name":"1Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane E.","family":"Brumbaugh","sequence":"additional","affiliation":[{"name":"1Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayden","family":"Wilhelm","sequence":"additional","affiliation":[{"name":"2Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Bosley","sequence":"additional","affiliation":[{"name":"2Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammy","family":"Schultz","sequence":"additional","affiliation":[{"name":"2Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Schram","sequence":"additional","affiliation":[{"name":"1Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Cristina","family":"Gallup","sequence":"additional","affiliation":[{"name":"3Department of Nursing, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond C.","family":"Stetson","sequence":"additional","affiliation":[{"name":"1Division of Neonatal Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"issue":"11","key":"2026083119573431900_r1","doi-asserted-by":"crossref","first-page":"1242","DOI":"10.3390\/healthcare13111242","article-title":"Neonatal tracheal intubation in the NICU: a literature review","volume":"13","author":"Schaefer-Randolph","year":"2025","journal-title":"Healthcare (Basel)."},{"issue":"6","key":"2026083119573431900_r2","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/j.bja.2021.02.021","article-title":"Difficult tracheal intubation in neonates and infants. 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