Video vs Traditional Laryngoscopy: Which Is Better for Neonatal Intubation?

Tracheal intubation in newborns—especially those who are critically ill at birth or in neonatal intensive care—remains one of the most challenging procedures in neonatology. A growing number of clinicians are now turning to video laryngoscopy (VL) as an alternative to traditional direct laryngoscopy (DL). But does this technology truly improve outcomes for our most vulnerable patients?

A recent systematic review and meta-analysis set out to answer this question by comparing the success and safety of video versus traditional laryngoscopy for tracheal intubation in infants, either in the delivery room or neonatal unit.

What Was Done?

Researchers searched five major databases—MEDLINE, Embase, Cochrane Library, CINAHL, and Clinical Trials registries—through August 2024, with no language restrictions. The review included six randomized controlled trials (RCTs) (817 infants, 862 intubations) and four observational studies (3,289 infants, 3,342 intubations).

Key outcomes included:

• Overall success of intubation

• Success on first attempt

• In-hospital mortality and adverse events

• Operator perceptions and experiences

Risk of bias was assessed using standard Cochrane tools, and certainty of evidence was graded using the GRADE framework.

What Did the Study Find?

• RCT Findings:

  • Higher success with video laryngoscopy: VL significantly increased the likelihood of successful intubation overall (RR 1.43; 95% CI 1.15–1.77).

  • Greater success at first attempt: VL showed even more benefit on first attempts (RR 1.56; 95% CI 1.33–1.84), especially among inexperienced intubators.

  • Safety outcomes unclear: Mortality and adverse events (e.g., airway trauma, bradycardia, desaturation) did not clearly favor either approach.

  • Operator satisfaction was inconsistently reported and could not be pooled.

• Observational Study Findings:

  • Consistent with RCTs, video laryngoscopy improved first-attempt success (RR 1.78; 95% CI 1.16–2.74), although the certainty of this evidence was very low due to design limitations.

Why It Matters

While traditional laryngoscopy has long been the standard, video laryngoscopy offers clear technical advantages, especially for new trainees and less experienced clinicians. The ability to visualize the airway more clearly and share views in real-time with supervising staff may help reduce errors and improve learning curves. Though the data on mortality or serious adverse events remain inconclusive, the improved success rates at first attempt are clinically relevant—particularly when time and precision are critical.

Conclusion

This systematic review supports the use of video laryngoscopy as a preferred method for neonatal intubation, especially in teaching environments or where first-pass success is essential. While more research is needed on safety outcomes and long-term effects, these findings should encourage neonatal units to consider integrating video laryngoscopy into routine practice and training programs.