AIM: Tracheal intubation (TI) is pivotal in managing critically ill neonates. This study aims to investigate the disparities in exposure and training techniques that affect self-perceived confidence in neonatal fellows concerning TI. METHODS: A comprehensive, structured questionnaire-based survey was conducted among neonatal trainees from October to November 2022. Self-perceived confidence in TI was evaluated using a Likert scale, ranging from 1 to 10. The trainees who scored below seven were categorised as under-confident, while those who scored seven or more were considered confident in TI. An analysis was done to assess the differences in exposure, training and clinical policies related to TI in both groups. A P-value <
0.05 was considered significant. RESULTS: The final dataset consisted of 93 trainees. Confidence was higher among those who had independently performed TI on more than 30 neonates during their postgraduate training (relative risk (RR) 1.5 (1.03-2.1), P = 0.02) and super-specialty training (RR 1.5 (1.20-1.93), P = 0.0004). Confidence was also significantly associated with training programmes that incorporated written checklists for intubation instruments and policies (RR 1.4 (1.1-1.8), P = 0.006), conducted debriefing sessions after each TI attempt (RR 1.3 (1.03-1.6), P = 0.005), and implemented regular simulation programmes (RR 1.4 (1.1-1.8), P = 0.0006). CONCLUSIONS: Trainees with increased opportunities for intubation and training programmes featuring regular simulations and debriefing sessions tend to possess higher self-perceived confidence in TI.