Stylet Use During Neonatal Intubation

Neonatal tracheal intubation is a challenging skill in part due to the unique characteristics of the small, anteriorly placed neonatal airway in comparison to that of a child or adult. Substantial advances in neonatal intubation technology have brought innovative tools to the bedside with the goal of improving tracheal intubation success and safety. The endotracheal tube introducer first described by Macintosh in the 1940s has largely been replaced by the plastic-coated aluminum wire termed “stylet.” While the stylet is used as a guide for directing the endotracheal tube through the vocal cords during intubation, research on this device has persistently failed to show a significant difference in the efficacy or safety of neonatal intubations with or without stylets. This review aims to summarize the historical context of neonatal intubation stylets, analyze the literature surrounding effectiveness of stylets, and examine safety and potential adverse events attributed to stylets. As neonatal airway management continues to evolve the stylet remains an area of clinical interest with opportunity to improve the ease and success of neonatal intubation.