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Neonatal Anatomy

NextGen Learning To Elevate Your Airway Practice

Overview

Yes, everything is smaller in neonates, but you need to consider more than just smaller relative size before attempting a neonatal intubation. The larger and more prominent occiput can cause obstruction when the neonate is supine, and the relatively large tongue can fall back and lead to airway obstruction.

Differences in spatial relationships also make neonatal intubation challenging: shorter necks, a floppy epiglottis, and a more cephalad and anterior larynx contribute to the difficulty. Finally, the delicate nature of neonatal tissue means that technique and precision are essential.

Rapid Review

Anatomical Differences

  1. Smaller Airway:
    • Neonates have a much smaller airway diameter, increasing the risk of obstruction or trauma.
    • Precision in selecting equipment size is critical.
  2. Prominent Occiput:
    • The larger relative occiput can cause the head to flex, leading to airway obstruction.
    • Positioning with a shoulder roll is often necessary to align the airway.
  3. Shorter Trachea:
    • The neonatal trachea is shorter, increasing the risk of endobronchial intubation if the tube is too far.
    • Proper tube placement must be confirmed (e.g., via auscultation or capnography).
  4. Floppy Epiglottis:
    • The epiglottis is more flexible and angled, making visualization with a laryngoscope more challenging.
  5. Anterior and Cephalad Larynx:
    • The larynx is positioned higher (C3-C4) than adults (C4-C5), requiring adjustments in technique.

Dive Deeper

In this great video, Dr. Cheryl Gooden, a Pediatric Anesthesiologist and Associate Professor at Mt. Sinai Medical Center, discusses the key features of neonatal anatomy. We’ve shortened it to the most relevant part, but you can click this link to watch the full video.

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