NICU Intubation Toolkit | NICU Pocket Manual

INTUBATION TOOLKIT

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Weight (kg)

ⓘ Table | ETT Size: — mm | ETT Depth: — cm
Insertion depth at gums.

PremedicationSource

IV Drug	Dose	Onset	Duration	Risks	Reversal
Fentanyl^a Analgesia	1-5 μg/kg	1 minute	30-60 minutes	ⓘ Apnea Hypotension Sedation Rigid chest	Naloxone^b 0.01 mg/kg
Midazolam^c Sedation	0.05-0.1 mg/kg	1-5 minutes	20-30 minutes	ⓘ Apnea Hypotension Sedation Seizures Paradoxical agitation	Flumazenil 10-20 μg/kg
Vecuronium Paralysis	0.01 mg/kg	2-3 minutes	50-70 minutes	ⓘ Prolonged paralysis Bronchospasm	Neostigmine^d 0.03 mg/kg
Atropine Vagolytic	0.02 mg/kg	1-2 minutes	30-120 minutes	ⓘ Tachycardia Dry, hot skin	Antidote for neostigmine
^aFentanyl: Give over 3-5 minutes to reduce risk of rigid chest; mitigated by paralytic ^bNaloxone: IV/IM/SC q3-5 minutes PRN (max 2 doses) ^cMidazolam: Rarely needed for intubation; contraindicated in preterm infants ^dNeostigmine: Risk of bradycardia, bronchospasm, ↑ secretions

Weight (kg)	Gestation (weeks)	ETT Depth (gums, cm)	ETT Size^a (mm)
<0.5	<23	5.0-5.5	2.5^b
0.5-0.6	23-24	5.5	2.5^b
0.7-0.8	25-26	6.0	2.5^b
0.9-1.0	27-29	6.5	2.5
1.1-1.4	30-32	7.0	2.5-3.0^c
1.5-1.8	33-34	7.5	3.0
1.9-2.4	35-37	8.0	3.0-3.5^c
2.5-3.1	38-40	8.5	3.5
3.2-4.2	41-43	9.0	3.5^d
^aUse weight, if available, to choose ETT size ^bMay consider 2.0 mm ETT if < 0.9 kg / GA < 27 weeks ^c1.2-2.2 kg: 3.0 mm ETT; > 2.2 kg: 3.5 mm ETT ^dMay consider 4.0 mm ETT if > 4.2 kg / GA > 43 weeks

Corrected GA	Blade
≥37 weeks	No. 1
28–36 weeks	No. 0
<28 weeks	No. 00^a
^aMay consider No. 000 blade (shorter)