Team Stress and Adverse Events during Neonatal Tracheal Intubations: A Report from NEAR4NEOS

Rachel A. Umoren*, Taylor L. Sawyer, Anne Ades, Stephen Demeo, Elizabeth E. Foglia, Kristen Glass, Megan M. Gray, James Barry, Lindsay Johnston, Philipp Jung, Jae H. Kim, Jeanne Krick, Ahmed Moussa, Christine Mulvey, Vinay Nadkarni, Natalie Napolitano, Bin Huey Quek, Neetu Singh, Jeanne P. Zenge, Justine ShultsAkira Nishisaki

*Corresponding author for this work
2 Citations (Scopus)


Objective  This study aimed to examine the association between team stress level and adverse tracheal intubation (TI)-associated events during neonatal intubations. Study Design  TIs from 10 academic neonatal intensive care units were analyzed. Team stress level was rated immediately after TI using a 7-point Likert scale (1 = high stress). Associations among team stress, adverse TI-associated events, and TI characteristics were evaluated. Result  In this study, 208 of 2,009 TIs (10%) had high stress levels (score < 4). Oxygenation failure, hemodynamic instability, and family presence were associated with high stress level. Video laryngoscopy and premedication were associated with lower stress levels. High stress level TIs were associated with adverse TI-associated event rates (31 vs. 16%, p < 0.001), which remained significant after adjusting for potential confounders including patient, provider, and practice factors associated with high stress (odds ratio: 1.90, 96% confidence interval: 1.36-2.67, p < 0.001). Conclusion  High team stress levels during TI were more frequently reported among TIs with adverse events.

Original languageEnglish
JournalAmerican Journal of Perinatology
Issue number14
Pages (from-to)1417-1424
Number of pages8
Publication statusPublished - 01.12.2020

Research Areas and Centers

  • Academic Focus: Center for Brain, Behavior and Metabolism (CBBM)


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