# Apneic Oxygenation to Prevent Oxygen Desaturation During Intubation in the NICU

> **NIH NIH R21** · UNIVERSITY OF PENNSYLVANIA · 2022 · $270,389

## Abstract

Tracheal Intubation (TI) is a common, life-saving, high-risk procedure for critically ill infants.  
Adverse events occur in 18% of tracheal intubations performed in the NICU setting, and almost half 
(48%) of NICU intubations are complicated by severe oxygen desaturation (≥20% decline in 
pulse oximetry saturation [SpO2]). Severe desaturation is now recognized as an important 
contributor to neonatal morbidity and impaired neurodevelopmental outcomes.  While modifiable 
factors have been identified that prevent adverse tracheal intubation associated events, there are 
limited interventions that consistently prevent severe oxygen desaturation during intubation in 
NICU patients.
Typical practice during intubation in the NICU setting is to remove respiratory support during 
laryngoscopy  and tracheal intubation attempts.  Patients are often apneic during this period due 
to pre-medication administration, a practice that is recommended by the American Academy of 
Pediatrics.  Apneic oxygenation  is a strategy in which free flowing oxygen is provided via nasal 
cannula during laryngoscopy and tracheal intubation.  Apneic oxygenation has been demonstrated to 
prevent or delay oxygen desaturation during intubation in adults and older children.  To date, no 
published studies have systematically assessed the impact of apneic oxygenation during intubation 
for infants in the NICU setting. In this R21 application we propose a pilot randomized trial of 
infants ≥28 weeks corrected gestational age who undergo tracheal intubation in the NICU 
setting to determine if apneic oxygenation, compared with no respiratory support or oxygen during 
laryngoscopy and tracheal intubation attempt, reduces the magnitude of decline in oxygen saturation 
during tracheal intubation.

## Key facts

- **NIH application ID:** 10373276
- **Project number:** 1R21HD103927-01A1
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Elizabeth Foglia
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $270,389
- **Award type:** 1
- **Project period:** 2022-02-11 → 2024-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10373276

## Citation

> US National Institutes of Health, RePORTER application 10373276, Apneic Oxygenation to Prevent Oxygen Desaturation During Intubation in the NICU (1R21HD103927-01A1). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10373276. Licensed CC0.

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