The use of premedication for intubating very low birth weight infants in the neonatal intensive care unit: Results of a national survey.

Abstract

Objective: To explore barriers and perspectives of premedication use for non-emergent intubations of very low birth weight (VLBW) infants (less than 1,500 g).

Study design: A cross-sectional, online survey was distributed from January to April 2023 to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Data was analyzed using descriptive statistics and chi-square tests.

Results: Of the 521 respondents, the majority (81%, n=415) were neonatologists. Over half of respondents (69%, n=359) consider patient weight when selecting premedication. Most providers (78%, n=407) agreed that premedication should be used for non-emergent intubation of VLBW infants, while only 41% (n=216) felt similarly that muscle relaxants should be used. For infants over 1,500 g, 43% (n=153) reported frequent or regular muscle relaxant use compared with 28% (n=101) for VLBW infants. The most cited barrier to muscle relaxant use was surfactant delivery with planned return to non-invasive support. Unit guidelines were associated with significantly more premedication and muscle relaxant use (56% vs. 44%; OR 5.2, 95% CI 3.4-7.7, p<0.0001).

Conclusion: Most neonatal providers favor premedication for non-emergent intubation but are hesitant to use muscle relaxants for VLBW infants. Premedication guidelines may facilitate the use of both premedication and muscle relaxants for this population.