Computed tomography of three smaller-sized supraglottic airway device prototypes in stillborn low-birth-weight neonates.

BACKGROUND: Supraglottic airway devices are used for neonatal resuscitation and surfactant administration, but options for low-birth-weight neonates remain sparse. This study evaluated three smaller-sized supraglottic airway device prototypes in low-birth-weight stillborn neonates. METHODS: The smallest commercially available i-gel® (Intersurgical Ltd) (size 1.0) and three smaller-sized prototypes, Neo i-gel® sizes 0.65, 0.75, and 0.85, were evaluated. Anatomical positioning of the devices in stillborn neonates weighing more than 500 g was assessed using photon-counting CT. Measurements included device placement relative to perilaryngeal landmarks and impact on adjacent structures. RESULTS: Six stillborn neonates were included, comprising two neonates per weight category: (I) 500-750 g, (II) 1250-1750 g, and (III) 1750-2250 g. In weight category I, sizes 0.85 and 1.0 were too large to be inserted; for sizes 0.65 and 0.75, the results were inconclusive because of a fitting discrepancy within the group. In weight categories II and III, the anatomical fit was suitable for sizes 0.75 and 0.85. A weak trend showed that the effect on adjacent structures increased with larger device size. CONCLUSIONS: The smallest commercially available i-gel®, size 1.0, was markedly too large for all neonates weighing up to 1750 g and too large to be considered anatomically suitable for neonates weighing up to 2250 g. Our findings underscore the necessity of smaller supraglottic airway devices, but further functional validation is necessary before making any definitive weight-based recommendations.