Premedication for neonatal intubations: an unrecognized area for improvement

Abstract

Non-urgent endotracheal intubation is common in the neonatal intensive care unit (NICU). Previous studies have shown that conscious and awake intubations in neonates are painful and associated with adverse physiologic responses.1‒5 Several trials have demonstrated that premedication significantly improves intubation conditions, decreases the time and number of attempts needed to complete the intubation procedure, and minimizes the potential for intubation related airway trauma.6‒13 The Fetus and Newborn Committee of the American Academy of Pediatrics (2010) and Canadian Pediatric Society (2011) recommend premedication of infants before intubation when time permits.6,10 In addition, the International Evidence-Based Group for Neonatal Pain conclude that “tracheal intubation without the use of analgesia or sedation should be performed only for resuscitation in the delivery room or for life-threatening situations associated with the unavailability of intravenous access”.14 Nevertheless, concerns have also been raised regarding adverse effects related to premedication for neonatal intubation.15