Confirmation and reproducibility of endotracheal tube position by tracheal ultrasonography in preterms: expert versus trainee.

UNLABELLED: Tracheal intubation (TI) is critical in neonatal intensive care and delivery rooms, requiring precise placement of the endotracheal tube (ETT) to prevent complications. Various methods confirm ETT position; whilst chest radiography remains standard for identifying ETT depth, ultrasonography (USG) shows promise as a real-time, radiation-free alternative. That is why we aimed to evaluate the concordance between tracheal ultrasound (TUS) and chest x-ray to identify the depth of the ETT in the trachea in preterm neonates and to compare the reproducibility of TUS done by a trainee neonatologist and an expert radiologist. This cross-sectional study involved 85 preterm infants who had an ETT. Tracheal ultrasonography was performed by a neonatologist (who had been trained in chest ultrasonography for 3 months) and repeated by an expert radiologist. Operators were blinded to the radiographic results. The overall agreement was good, with near-complete concordance for ETT localization at the 2nd intercostal space across techniques: 89.4% (PSA 93.5%) between expert TUS and CXR, 82.4% (PSA 89.1%) between trainee TUS and CXR, and 89.1% (PSA 92.3%) between expert and trainee TUS.

CONCLUSION

Bedside tracheal ultrasonography is a reliable, fast, safe, and effective method for assessing endotracheal tube position in the NICU. With adequate training, neonatologists can perform the procedure independently which speeds up ETT position confirmation.

TRIAL REGISTRATION: The clinical trial was retrospectively registered on clinical trials.gov 7/17/2025.

GOV ID: NCT07073105. https://CLINICALTRIALS.GOV/STUDY/NCT07073105 .

WHAT IS KNOWN: • Improper endotracheal tube (ETT) placement and depth in the trachea can cause severe complications. • Chest X-ray is used for the identification of ETT depth in the trachea but causes delays and radiation exposure.

WHAT IS NEW: • Tracheal ultrasound offers rapid, radiation-free confirmation. • With brief training, a neonatology trainee achieved agreement with an expert radiologist in identifying the depth of ETT in the trachea in preterm infants.