Resuscitation & StabilizationProcedures

ET Tube Size & Depth

Neonatal intubation is time-critical and unforgiving of error: an oversized tube injures the airway, an undersized one leaks, and a tube placed too deep enters the right main bronchus. This calculator gives the endotracheal tube internal diameter and a starting insertion depth from the NRP 9th edition (2025) tables, by gestational age, weight, or nasal-tragus length.

Estimates from the NRP 9th edition (2025) tables. Depth is measured tip-to-gum (anterior edge of the upper gum at the midline), a change from the 8th edition's tip-to-lip. Always confirm tube placement clinically (rising heart rate, chest rise, symmetric breath sounds, exhaled CO₂ detector) and with a chest X-ray.

Nasal septum base → ear tragus

Enter a birth weight and/or gestational age to estimate tube size and depth.

Tube size (NRP 9th ed.)

WeightGAID
<800 g22–25 wk2.5*
800–1200 g26–28 wk2.5
1201–2200 g29–34 wk3.0
>2200 g>34 wk3.5

*2.0 mm ID optional if available

Depth at gum (NRP 9th ed.)

GADepthWeight
<235.0–5.5<500 g
23–245.5500–600
25–266.0700–800
27–296.5900–1000
30–327.01100–1400
33–347.51500–1800
35–378.01900–2400
38–408.52500–3100
41–439.03200–4200

Weiner GM, ed. Textbook of Neonatal Resuscitation, 9th ed. American Academy of Pediatrics & American Heart Association; 2025 (Lesson 5: Endotracheal Intubation).

Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369-373.

Frequently asked questions

How is ET tube depth estimated?

Weight-based (about weight in kg + 6 cm at the lip) or nasal–tragus length + 1 cm; the NRP 9th edition also provides gestational-age and weight tables. Confirm by exam and chest radiograph.

What ET tube size for a preterm infant?

Approximately 2.5 mm for under 1000 g/28 weeks, 3.0 mm for 1000–2000 g/28–34 weeks, and 3.5 mm above 2000 g/34 weeks.

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