- Design
- Retrospective multicentre registry cohort with inverse probability of treatment weighting
- Population
- 3,250 neonatal and infant tracheal intubation encounters
- Primary outcome
- First-attempt tracheal intubation success
- Effect
- Videolaryngoscopy adjusted risk ratio 0.89 (0.83–0.96) for success; desaturation 2.18 (1.57–2.79)
Videolaryngoscopy is recommended for neonatal and infant intubation on the logic that a better glottic view means a better first attempt. This registry study of 3,250 neonatal and infant encounters tested that in real-world practice, adjusting for confounders with inverse probability weighting.
Videolaryngoscopy did deliver a better glottic view, but was associated with a lower chance of first-attempt success than direct laryngoscopy (adjusted risk ratio 0.89) and with more than double the risk of desaturation (adjusted risk ratio 2.18). Respiratory adverse events were similar between the techniques.
This is an efficacy-effectiveness gap: the device shows the cords, but seeing them is not the same as placing the tube quickly, especially without standardised technique and training. The lesson is not to abandon videolaryngoscopy but to treat it as a skill that needs structured implementation and practice — and to keep direct laryngoscopy skills sharp. As an observational study, confounding by indication (harder airways getting videolaryngoscopy) is likely and tempers the comparison.
- Videolaryngoscopy gave a better glottic view but lower first-attempt success than direct laryngoscopy (adjusted risk ratio 0.89, 95% CI 0.83–0.96).
- Desaturation risk was more than doubled with videolaryngoscopy (adjusted risk ratio 2.18, 1.57–2.79).
- Respiratory adverse events were similar between the techniques.
- Implement videolaryngoscopy with structured training rather than assuming the device alone improves success, and keep direct laryngoscopy skills current.
Why it matters
It challenges the assumption that a better view automatically means a better intubation in the hardest airways.
Don't overread it
Observational and open to confounding by indication; it does not show videolaryngoscopy is harmful, only that the view did not translate into first-attempt success here.
The statistics, in plain English
An adjusted risk ratio of 0.89 for success means videolaryngoscopy did slightly worse on first-attempt success, and 2.18 for desaturation means roughly double the risk. Because this is observational, some of the gap may be that sicker or harder airways were given videolaryngoscopy in the first place.
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