Category: Pediatrics
Keywords: pediatrics, airway, intubation, infant, neonate (PubMed Search)
Posted: 4/10/2026 by Kathleen Stephanos, MD
(Updated: 4/11/2026)
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BOTTOM LINE:
A 2024 meta analysis from the European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia worked to develop joint guidelines for best practices for intubation of neonates and infants.
While this guide is focused primarily on anesthesia and operative care, several of the recommendations have practical application to the EM and ICU as well.
They focused on general guidance including ensuring appropriate anesthesia and analgesia during intubation. But also discussed that videolaryngoscopy with standard blades is the most appropriate first line for all intubations in this age group. It allows for appropriate visualization either directly or by video and for learners allows instructors to observe as well.
When there are difficulties with intubation, hyperangulated blades have very high success rates, but LMA and video assisted intubation with a fiberoptic scope are also appropriate next steps for securing an airway.
When intubating, uncuffed endotracheal tubes are acceptable in all infants though cuffed are also safe in infants over 3kg in weight.
Finally, while apneic oxygenation is regularly used in adults, it is also recommended in the neonatal period to avoid hypoxia.
Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J, Fuchs A, Garcia-Marcinkiewicz A, Habre W, Heath C, Johansen M, Kaufmann J, Kleine-Brueggeney M, Kovatsis PG, Kranke P, Lusardi AC, Matava C, Peyton J, Riva T, Romero CS, von Ungern-Sternberg B, Veyckemans F, Afshari A; and airway guidelines groups of the European Society of Anaesthesiology and Intensive Care (ESAIC) and the British Journal of Anaesthesia (BJA). Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines. Eur J Anaesthesiol. 2024 Jan 1;41(1):3-23.
