Are newborns receiving premedication before elective intubation?
OBJECTIVE
To determine the extent and type of premedication used for elective endotracheal intubation in neonatal intensive care units (NICUs).


METHODS
A pretested questionnaire was distributed via e-mail to the program directors of the neonatology divisions with accredited fellowship programs in Neonatal-Perinatal Medicine in the United States.


RESULTS
Of the 100 individuals contacted, 78 (78%) participated in the survey. Only 34 of the 78 respondents (43.6%) always use any premedication for elective intubation. Nineteen respondents (24.4%) reported to have a written policy regarding premedication. Morphine or fentanyl was used most commonly (57.1%), with a combination of opioids and midazolam or other benzodiazepines used less frequently. Fourteen respondents (25%) also use muscle relaxants with sedation for premedication, but only nine respondents combined paralysis with atropine and sedation.


CONCLUSIONS
Most neonatology fellowship program directors do not report always using premedication for newborns before elective endotracheal intubation despite strong evidence of physiologic and practical benefits. Only a minority of the NICUs has written guidelines for sedation, which may preclude effective auditing of this practice. Educational interventions may be necessary to ensure changes in clinical practice.
Sarkar
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Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, 48109, USA. subratas@med.umich.edu
Schumacher
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RE
Baumgart
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Donn
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SM
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D003625:Data Collection; D005257:Fellowships and Scholarships; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000379:methods; D003473:Neuromuscular Nondepolarizing Agents / Q000627:therapeutic use*; D010146:Pain / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014481:United States
D000701:Analgesics, Opioid; D003473:Neuromuscular Nondepolarizing Agents