Effect of neck position on endotracheal tube location in low birth weight infants

Neck position can affect the position of the tip of the endotracheal tube ( ETT) in normal neonates; this has not been systematically investigated in l ow birth weight (LBW) neonates. It was our intention to determine the effec t of neck flexion and extension on ETT position in LBW infants. Eight LBW o rotracheally-intubated infants underwent postmortem anteroposterior chest r adiographs with the neck in a neutral position, in 55 degrees flexion, and in 55 degrees extension. Measurements from the thoracic inlet to the ETT we re obtained in each position. The ETT always moved caudad with neck flexion (P = 0.001) and cephalad with neck extension (P = 0.001). The mean extent of ETT displacement was 3.1 mm (SD, 1.7 mm) with neck flexion, and 7.4 mm (SD, 5.2 mm) with extension (P < 0.05). We conclude that in LBW infants: 1) the direction of Err movement with neck flexion and extension is predictable and identical to that seen in term in fants and children, and 2) neck flexion should not be a principal considera tion in management of ETT location. (C) 1999 Wiley-Liss, Inc.