Supraglottic Airway Devices

The use of supraglottic airway (SA) devices in neonatal medicine was described almost three decades ago, and SA devices have been included in international neonatal resuscitation guidelines since 2000. Over this time, the evidence-base supporting their use has grown. During neonatal resuscitation, the likelihood of first attempt successful insertion and effective ventilation is high in comparison to either face mask ventilation or endotracheal intubation. Despite these recommendations, very few healthcare professionals use them in clinical practice. This may be attributed to a lack of awareness regarding their safety and efficacy, limited opportunities for training leading to a lack of confidence in their use, and lack of routine access to the various SA devices. In this review, we describe the evidence related to SA use in a variety of neonatal medicine scenarios, including as an alternate airway to provide positive pressure ventilation during neonatal resuscitation, for the management of a difficult airway, during neonatal transport, as a conduit for surfactant administration, as an adjunct to bronchoscopy, and for administering general anesthesia. The advantages and disadvantages of SA devices and the characteristics of the various generations of SA devices are explained. Finally, this review identifies the gaps of knowledge in the current literature in relation to SA device use in newborn infants and potential areas of research and innovation.