Background and aim Intubation in NICU is a daily procedure, that may be associated with serious complications. We studied the effect of different factors that may contribute to the difficulty and success of semi elective endotracheal intubation of sick infants managed at NICU of KAMC-Riyadh.

Methods A retrospective review of prospectively collected data of infants that had semi elective endotracheal intubation from 1/1/2010 till 1/7/2011. The studied factors were : experience of intubating physician, body weight and post conceptional age (PCA) of the infants, premedication. Success of intubation was assessed by number of trials, pain score, and occurrence of bradycardia and or desaturation.

Results 180 infants had semi elective intubation. Birth weight (490–4995 gms), PCA (25 to 53 weeks). Premedication was used in 108 infants; Fentanyl:66, Midazolam : 33 infants, and both medications: 9 infants.

Univariate analysis showed that difficult intubation (need for ≥3 trials of intubation) positively correlates with junior intubating physicians (p < 0.001) and bradycardia (heart rate <80/min) was associated with smaller body weight (p: 0.036).

Multilogestic Regression analysis showed independent correlation between difficulty of intubation and total number of attempts of intubation with the junior (RI, and R2 & Service physicians of less than 12 months experience) intubating physician (p 0.001 and 0.01).

Using premedication had no contribution to success of intubation, number of attempts of intubation and occurrence of Bradycardia and/ or desaturation.

Conclusion The only predictor of difficult intubation of infants in NICU in our study was having intubation by junior physician, while premedication did not contribute to the success of intubation.