A randomised controlled trial in India assigned 42 neonates under 35 weeks' gestation undergoing less invasive surfactant administration to video laryngoscopy or conventional direct laryngoscopy, with pain measured immediately afterwards on the FANS score.
Median FANS was 2 (IQR 2 to 4) with video laryngoscopy and 2 (IQR 1 to 4) with conventional, p = 0.79. No secondary outcome differed, including the number of attempts and the time taken — though the operators were neonatologists already experienced with conventional laryngoscopes, which is exactly the group least likely to benefit from a video device.
The more useful observation is in the authors' conclusion rather than the comparison. Pain during the procedure was moderate and short-lived regardless of technique, and manageable with non-pharmacological measures. That matters because the alternative — sedation or analgesia before a procedure whose entire purpose is to avoid intubation — carries the apnoea risk that less invasive surfactant administration exists to prevent.
- 42 neonates is small; this excludes only a large difference
- Operators were already expert with conventional laryngoscopy
- Pain was moderate and brief with both techniques
- Supports non-pharmacological comfort measures rather than pre-procedural sedation
- Says nothing about first-pass success in less experienced hands
The statistics, in plain English
With 42 neonates and identical medians, this is an underpowered null: it excludes a large difference and cannot rule out a modest one. A p value of 0.79 does not mean the techniques are equivalent — it means this trial found no evidence they differ, which is a weaker and more honest statement.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for paediatrics, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free