NN ETT. DL v glideoscope

Good question — this is something that often comes up in neonatal airway management.

Direct Laryngoscopy (DL) vs. Videolaryngoscopy (e.g., GlideScope) in Neonates:

Direct Laryngoscopy (DL):

• Advantages:
  
• Traditional method, widely taught and available everywhere.
• Quick if the operator is skilled.
• Familiarity helps in emergency situations.
• Challenges:
  
• Neonates have a large occiput, floppy epiglottis, and an anterior larynx, making visualization harder.
• Steeper learning curve, especially for trainees.
• Limited view if positioning or anatomy is difficult.

Videolaryngoscopy (GlideScope / other VLs):

• Advantages:
  
• Provides an indirect view of the glottis on a screen, which can improve glottic visualization in neonates.
• Easier for teaching since instructors can see the same view as the trainee.
• Helpful in anatomically difficult airways.
• Challenges:
  
• Neonatal versions of the GlideScope have a relatively steep blade curvature → sometimes makes passing the tube harder even if you see the cords well.
• Requires familiarity with stylet shaping.
• More expensive and not always available in every setting.
• May take longer if the operator is inexperienced.

Evidence from studies:

• Multiple randomized trials suggest videolaryngoscopy improves the view of the glottis compared to DL in neonates, but time to successful intubation is often longer, especially for less-experienced operators.
• In emergencies (e.g., neonatal resuscitation), direct laryngoscopy may still be faster in expert hands.
• For teaching/training, videolaryngoscopy is often superior.

👉 Summary:

• For experienced providers in urgent settings, direct laryngoscopy may be easier and faster.
• For learners, anticipated difficult airways, or teaching situations, GlideScope/videolaryngoscopy can be easier because it improves visualization.

Would you like me to make you a table comparing DL vs GlideScope in neonates (focusing on ease of use, success rates, and training)?