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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Italian Journal of Pediatrics 1/2018

Technical realization of a sensorized neonatal intubation skill trainer for operators’ retraining and a pilot study for its validation

Italian Journal of Pediatrics > Ausgabe 1/2018
Davide Panizza, Rosa T. Scaramuzzo, Francesca Moscuzza, Ilaria Vannozzi, Massimiliano Ciantelli, Marzia Gentile, Ilaria Baldoli, Selene Tognarelli, Antonio Boldrini, Armando Cuttano
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Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s13052-017-0435-z) contains supplementary material, which is available to authorized users.



In neonatal endotracheal intubation, excessive pressure on soft tissues during laryngoscopy can determine permanent injury. Low-fidelity skill trainers do not give valid feedback about this issue. This study describes the technical realization and validation of an active neonatal intubation skill trainer providing objective feedback.


We studied expert health professionals’ performances in neonatal intubation, underlining chance for procedure retraining. We identified the most critical points in epiglottis and dental arches and fixed commercial force sensors on chosen points on a ©Laerdal Neonatal Intubation Trainer. Our skill trainer was set up as a grade 3 on Cormack and Lehane’s scale, i.e. a model of difficult intubation. An associated software provided real time sound feedback if pressure during laryngoscopy exceeded an established threshold. Pressure data were recorded in a database, for subsequent analysis with non-parametric statistical tests. We organized our study in two intubation sessions (5 attempts each one) for everyone of our participants, held 24 h apart. Between the two sessions, a debriefing phase took place. In addition, we gave our participants two interview, one at the beginning and one at the end of the study, to get information about our subjects and to have feedback about our design.


We obtained statistical significant differences between consecutive attempts, with evidence of learning trends. Pressure on critical points was significantly lower during the second session (p < 0.0001). Epiglottis’ sensor was the most stressed (p < 0.000001). We found a significant correlation between time spent for each attempt and pressures applied to the airways in the two sessions, more significant in the second one (shorter attempts with less pressure, rs = 0.603).


Our skill trainer represents a reliable model of difficult intubation. Our results show its potential to optimize procedures related to the control of trauma risk and to improve personnel retraining.
Additional file 1: Figure S1. A. epiglottis’ force sensor allocation on skill trainer. B. ©LabVIEW graphic interface. For force sensors: green - “untouched sensor”, yellow - “under-threshold touched sensor”, red - “over-threshold touched sensor”. For head position: green - sniffing position, red - inappropriate hyperextension. To the red status are associated two different acoustic alarms. (TIFF 468 kb)
Additional file 2: Table S2. Mean times of operators scheduled for attempts in two session. (DOCX 12 kb)
Additional file 3: Table S3. Mean pressure values scheduled for attempts in two session. We considered data with outliers exclusion. (DOCX 13 kb)
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