Endotracheal intubation is one of the essential procedures used to provide respiratory support and save the lives of neonates and infants, particularly in intensive care units and cases of respiratory distress. Despite its importance, intubation in this age group is associated with a range of risks and complications that differ from those seen in older children and adults. This is mainly due to the small size of the airway, the sensitivity of its tissues, and the limited physiological reserve of neonates. Characteristics That Increase the Risks of Intubation : Neonates have a very small airway, with the diameter of the subglottic region measuring no more than 3–4 mm. The airway mucosa is also thin, highly vascular, and susceptible to injury. Therefore, even minor swelling in this region can cause significant airway narrowing and increased difficulty in breathing. The shape of the cricoid cartilage in neonates, particularly premature infants, also differs from that of adults, making the selection of an appropriately sized endotracheal tube extremely important. The risk of complications is further increased in low-birth-weight and premature infants because of their limited oxygen reserve and higher oxygen consumption relative to body weight. Major Potential Complications : Hypoxemia and hemodynamic instability are among the most common acute complications during intubation. They may present as decreased oxygen saturation, hypotension, or disturbances in heart rate. The risk of these complications increases significantly with repeated intubation attempts, as each additional attempt may increase the likelihood of adverse events. Emergency intubation is also associated with a higher risk compared with planned intubation. Direct airway injuries may also occur as a result of tube insertion or the use of intubation equipment. These injuries may include laryngeal edema, bleeding, trauma, and, in severe cases, tracheal or pharyngeal perforation. One of the most important long-term complications is subglottic stenosis, which may result from prolonged pressure of the endotracheal tube on the tissues. This can lead to impaired blood supply, ulceration, and subsequent formation of scar tissue that narrows the airway. It may later present as stridor, breathing difficulty, or difficulty with extubation. The effects of repeated intubation are not limited to the respiratory system. Multiple intubation attempts in some extremely low-birth-weight infants have been associated with an increased risk of neurological complications. This may be related to episodes of hypoxemia and hemodynamic instability that can accompany repeated procedures. Risk Factors and Prevention : The risks of intubation are increased in premature and low-birth-weight infants, as well as when an inappropriate tube size is used or multiple attempts are performed by an inexperienced operator. Unplanned extubation may also necessitate emergency reintubation, thereby increasing the likelihood of complications. These risks can be reduced through careful procedural planning, selection of an experienced operator, appropriate endotracheal tube sizing, and the use of video laryngoscopy when available. Adherence to premedication protocols and continuous monitoring of oxygenation and vital signs are also important. In addition, the use of checklists and continuous training of healthcare teams can improve first-attempt success and reduce complications. Proper fixation of the endotracheal tube is an important measure for preventing unplanned extubation. The continued need for intubation should also be reassessed regularly, particularly in infants requiring prolonged mechanical ventilation. Conclusion : Endotracheal intubation is an essential life-saving procedure for many neonates and infants. However, the small size of their airway, the sensitivity of its tissues, and their limited physiological reserve make this population more vulnerable to complications.Reducing the number of intubation attempts, selecting the appropriate tube size, involving experienced healthcare professionals, and using modern techniques such as video laryngoscopy are among the most important measures for improving patient safety. Therefore, the goal is not to avoid intubation when it is clinically necessary, but rather to perform it with the highest possible level of precision and safety, while continuously monitoring the patient and minimizing modifiable factors that may lead to airway injury or short- and long-term complications. 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