Objective
To evaluate the association between ETT tip position and adverse pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants who had ETT insertion length estimated using weight +6 guide.

Study design
85 infants had CXR in the first week reviewed for right-sided atelectasis, air leaks and uneven lung inflation. The first CXR was later reviewed to document the ETT tip. Regression analysis was performed.

Results
Forty (46%) infants had ETT tip between first and second thoracic vertebrae (optimal position) compared to 45 (53%) who had the ETT tip outside this range (suboptimal position). Infants with suboptimal ETT were ventilated for longer (6.1 vs.15.9 days, p=0.004). The odds of adverse outcomes was 9 (95%CI 1.37, 58.7) times higher among infants who did not have ETT at optimal position compared to infants who had ETT at the optimal position. 

Conclusion
Weight+6 guide is not recommended to estimate ETT insertion length in extremely preterm infants.

Weight-based guide over-estimates endotracheal tube tip position in extremely preterm infants