Challenges and Strategies in Managing Difficult Airway in Newborns: A Review of Emergency Procedures

• DOI: https://doi.org/10.22533/at.ed.1594982408119

• Palavras-chave: Neonatal airway management; Difficult airway in neonates; Video laryngoscopy; Supraglottic airway devices; Emergency procedures in neonatology.

• Keywords: Neonatal airway management; Difficult airway in neonates; Video laryngoscopy; Supraglottic airway devices; Emergency procedures in neonatology.

• Abstract: INTRODUCTION The management of difficult airways in neonates is a significant challenge due to unique anatomical and physiological factors that complicate traditional intubation and airway stabilization techniques. Congenital anomalies, prematurity, and developmental factors contribute to airway obstruction risks, necessitating tailored approaches in emergency settings. While tools such as video laryngoscopy and simulation-based training offer advancements, logistical and financial barriers hinder their universal implementation. The need for specialized devices and pharmacological protocols highlights existing gaps in neonatal airway management research and practices. OBJETIVE To evaluate the challenges and strategies involved in managing difficult airways in newborns, focusing on the efficacy of current emergency procedures and interventions in neonatal care. METHODS This is a narrative review which included studies in the MEDLINE – PubMed (National Library of Medicine, National Institutes of Health), COCHRANE, EMBASE and Google Scholar databases, using as descriptors: “Neonatal Airway Management” OR “Difficult Airway in Newborns” OR “Emergency Airway Procedures” OR “Neonatal Intubation Techniques” OR “Video Laryngoscopy in Neonates” in the last  years. RESULTS AND DISCUSSION The results indicate a considerable challenge in neonatal airway management due to anatomical constraints and device limitations. Video laryngoscopy has improved intubation success rates by enhancing visibility, yet variability in its effectiveness and cost-related barriers limit its widespread use. Pharmacological management requires careful dosing tailored to neonates’ sensitive physiology, though limited neonate-specific research complicates drug administration. Simulation-based training has demonstrated benefits in skill retention and procedural confidence, while multidisciplinary approaches show improved outcomes in complex cases. The use of standardized risk assessment protocols has been advantageous, but universal adoption remains inconsistent. The field continues to advance through collaborative research into specialized devices and emerging technologies. CONCLUSION Difficult airway management in neonates requires specialized strategies to address anatomical and physiological challenges unique to this population. While advances in tools and training improve procedural success, barriers such as equipment availability and high costs hinder universal adoption. A continued focus on neonatal-specific research, especially regarding pharmacology and device design, is essential. Implementing standardized protocols and exploring emerging technologies will play a pivotal role in advancing neonatal airway management across diverse healthcare settings.