INTRODUCTION: The optimal placement of the endotracheal tube (ETT) in ventilated neonates is essential but birth weight (BW) may be not the best parameter to predict it. A previous study suggested that shoulder umbilical length (SUL) might be superior. The aim of this study is a direct comparison between SUL vs. BW as predictor of optimal ETT placement in Malaysian ventilated neonates. METHODS: All neonates requiring ventilation in the NICU of Hospital Universiti Sains Malaysia during the 5 months study period were eligible to enter this randomized controlled trial. Babies included in this study were randomized in two groups: the tube depth was determined based on the SUL for the intervention group and based on the BW for the control group. The main outcome measure was mal-positioning of the ETT as seen on the chest x-ray performed within 1 hour after intubation. Tube placement was assessed by two neonatologists, blinded to the allocation. Data were analysed using SPSS, version 24. RESULTS: One hundred and ten (110) babies were randomized, 55 in each group. The ETT was mal-positioned (requiring adjustment in 13/55 babies (23%) for the SUL group and 22/55 babies (40%) in the BW group (p=0.06) CONCLUSION: In the SUL group, less babies showed a need for tube adjustment than in the BW group. The difference did not reach statistical significance. While, a larger study may be necessary to show statistical significance, the difference shown in this study may be large enough to be of clinical significance.