Am J Perinatol 2015; 32(09): 821-824
DOI: 10.1055/s-0034-1543987
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Premedication Use Before Nonemergent Intubation in the Newborn Infant

Hemananda K. Muniraman
1   Department of Pediatrics, SUNY Downstate School of Medicine, Brooklyn, New York
,
Jonathan Yaari
1   Department of Pediatrics, SUNY Downstate School of Medicine, Brooklyn, New York
,
Ivan Hand
1   Department of Pediatrics, SUNY Downstate School of Medicine, Brooklyn, New York
› Author Affiliations
Further Information

Publication History

24 September 2014

07 November 2014

Publication Date:
21 January 2015 (online)

Abstract

Objective In 2010, an American Academy of Pediatrics (AAP) clinical report recommended that except for emergent situations, premedication should be used for all endotracheal intubations in newborns. The purpose of this study is to ascertain the current practice of premedication before elective intubation.

Study Design An online, survey-based questionnaire on the practice of premedication before nonemergent intubations was distributed via e-mail to neonatologists who are members of the Perinatal Section of the AAP.

Results Although 72% of respondents believed premedication should be used in nonemergent intubations, only 34% of the respondents report frequently premedicating before intubation with significant variation among the neonatal units (46% among level 4 units and 27% in level 3 and 2 units) p = 0.000. About 44% of respondents report having a written protocol or guideline on premedication which significantly correlated with the use of premedication (62% in level 4, 33% in level 3, and 16% in level 2 units), p = 0.000.

Conclusion Despite a recent AAP clinical report recommending the use of premedication before nonemergent endotracheal intubation, only one-third of neonatologists report frequent use of premedication and less than half of the institutions have a written protocol on premedication.

 
  • References

  • 1 Dempsey EM, Al Hazzani F, Faucher D, Barrington KJ. Facilitation of neonatal endotracheal intubation with mivacurium and fentanyl in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2006; 91 (4) F279-F282
  • 2 Barrington KJ. Position Statement: Premedication for endotracheal intubation in the newborn infant. Paediatr Child Health (Oxford) 2011; 16 (3) 159-164
  • 3 Pereira e Silva Y, Gomez RS, Marcatto JdeO, Maximo TA, Barbosa RF, Simões e Silva AC. Morphine versus remifentanil for intubating preterm neonates. Arch Dis Child Fetal Neonatal Ed 2007; 92 (4) F293-F294
  • 4 Ghanta S, Abdel-Latif ME, Lui K, Ravindranathan H, Awad J, Oei J. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 2007; 119 (6) e1248-e1255
  • 5 VanLooy JW, Schumacher RE, Bhatt-Mehta V. Efficacy of a premedication algorithm for nonemergent intubation in a neonatal intensive care unit. Ann Pharmacother 2008; 42 (7) 947-955
  • 6 Hassid S, Nicaise C, Michel F , et al. Randomized controlled trial of sevoflurane for intubation in neonates. Paediatr Anaesth 2007; 17 (11) 1053-1058
  • 7 Bhutada A, Sahni R, Rastogi S, Wung JT. Randomised controlled trial of thiopental for intubation in neonates. Arch Dis Child Fetal Neonatal Ed 2000; 82 (1) F34-F37
  • 8 Roberts KD, Leone TA, Edwards WH, Rich WD, Finer NN. Premedication for nonemergent neonatal intubations: a randomized, controlled trial comparing atropine and fentanyl to atropine, fentanyl, and mivacurium. Pediatrics 2006; 118 (4) 1583-1591
  • 9 Lemyre B, Cheng R, Gaboury I. Atropine, fentanyl and succinylcholine for non-urgent intubations in newborns. Arch Dis Child Fetal Neonatal Ed 2009; 94 (6) F439-F442
  • 10 Oei J, Hari R, Butha T, Lui K. Facilitation of neonatal nasotracheal intubation with premedication: a randomized controlled trial. J Paediatr Child Health 2002; 38 (2) 146-150
  • 11 Le CN, Garey DM, Leone TA, Goodmar JK, Rich W, Finer NN. Impact of premedication on neonatal intubations by pediatric and neonatal trainees. J Perinatol 2014; 34 (6) 458-460
  • 12 O'Donnell CP, Kamlin CO, Davis PG, Morley CJ. Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics 2006; 117 (1) e16-e21
  • 13 Marshall TA, Deeder R, Pai S, Berkowitz GP, Austin TL. Physiologic changes associated with endotracheal intubation in preterm infants. Crit Care Med 1984; 12 (6) 501-503
  • 14 Kelly MA, Finer NN. Nasotracheal intubation in the neonate: physiologic responses and effects of atropine and pancuronium. J Pediatr 1984; 105 (2) 303-309
  • 15 Millar C, Bissonnette B. Awake intubation increases intracranial pressure without affecting cerebral blood flow velocity in infants. Can J Anaesth 1994; 41 (4) 281-287
  • 16 Friesen RH, Honda AT, Thieme RE. Changes in anterior fontanel pressure in preterm neonates during tracheal intubation. Anesth Analg 1987; 66 (9) 874-878
  • 17 Hickey PR, Hansen DD, Wessel DL, Lang P, Jonas RA, Elixson EM. Blunting of stress responses in the pulmonary circulation of infants by fentanyl. Anesth Analg 1985; 64 (12) 1137-1142
  • 18 Raju TNN, Vidyasagar D, Torres C, Grundy D, Bennett EJ. Intracranial pressure during intubation and anesthesia in infants. J Pediatr 1980; 96 (5) 860-862
  • 19 Bonow FP, Piva JP, Garcia PC, Eckert GU. Assessment of intubation procedures at reference pediatric and neonatal intensive care units [in Portuguese]. J Pediatr (Rio J) 2004; 80 (5) 355-362
  • 20 Goldberg ME, Larijani GE, Azad SS , et al. Comparison of tracheal intubating conditions and neuromuscular blocking profiles after intubating doses of mivacurium chloride or succinylcholine in surgical outpatients. Anesth Analg 1989; 69 (1) 93-99
  • 21 Porter FL, Wolf CM, Gold J, Lotsoff D, Miller JP. Pain and pain management in newborn infants: a survey of physicians and nurses. Pediatrics 1997; 100 (4) 626-632
  • 22 Carbajal R, Eble B, Anand KJS. Premedication for tracheal intubation in neonates: confusion or controversy?. Semin Perinatol 2007; 31 (5) 309-317
  • 23 Kumar P, Denson SE, Mancuso TJ ; Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Premedication for nonemergency endotracheal intubation in the neonate. Pediatrics 2010; 125 (3) 608-615
  • 24 Anand KJS ; International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001; 155 (2) 173-180
  • 25 Sagarin MJ, Chiang V, Sakles JC , et al; National Emergency Airway Registry (NEAR) investigators. Rapid sequence intubation for pediatric emergency airway management. Pediatr Emerg Care 2002; 18 (6) 417-423
  • 26 Wheeler B, Broadbent R, Reith D. Premedication for neonatal intubation in Australia and New Zealand: a survey of current practice. J Paediatr Child Health 2012; 48 (11) 997-1000
  • 27 Sarkar S, Schumacher RE, Baumgart S, Donn SM. Are newborns receiving premedication before elective intubation?. J Perinatol 2006; 26 (5) 286-289
  • 28 Chaudhary R, Chonat S, Gowda H, Clarke P, Curley A. Use of premedication for intubation in tertiary neonatal units in the United Kingdom. Paediatr Anaesth 2009; 19 (7) 653-658
  • 29 Mosalli R, Shaiba L, Alfaleh K, Paes B. Premedication for neonatal intubation: Current practice in Saudi Arabia. Saudi J Anaesth 2012; 6 (4) 385-392
  • 30 de Kort EH, Reiss IK, Simons SH. Sedation of newborn infants for the INSURE procedure, are we sure?. Biomed Res Int 2013; ,(e-pub ahead of print). doi: 10.1155/2013/892974
  • 31 Welzing L, Kribs A, Huenseler C, Eifinger F, Mehler K, Roth B. Remifentanil for INSURE in preterm infants: a pilot study for evaluation of efficacy and safety aspects. Acta Paediatr 2009; 98 (9) 1416-1420
  • 32 Greenwood CS, Colby CE. Pharmacology review: premedication for endotracheal intubation of the neonate: what is the evidence?. Neoreviews 2009; 10: e31