Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events.
BACKGROUND
There has been a significant increase in premedication use for neonatal intubation in the UK over the past decade. We aimed to determine the adverse events during neonatal intubation using the most commonly used premedication regimen in the UK.


CONCLUSIONS
We prospectively studied all intubations performed using morphine, suxamethonium and atropine during a 3-month period in three UK tertiary neonatal units. Premedication was administered for 87/93 (94%) of intubations. Median time taken to prepare premedication was 16 min (IQR 10-35). Median time to successful intubation was 5 min (IQR 2-9) following premedication. Median lowest recorded oxygen saturation after administration of premedication was 65% (IQR 39-85). A bradycardia in the range 61-99/min accompanied the procedure in 24/93 (26%) intubations, with a median duration of bradycardia of 8 s (IQR 1-10).


CONCLUSIONS
Despite the widespread move to premedication for neonatal intubation, many deficiencies in everyday practice remain. The rate of haemodynamic complications is high in this commonly used premedication regimen. This study shows that there are important factors to control at the local level in terms of timely preparation and administration of premedication drugs, training and supervision of staff carrying out this high-risk procedure.
Venkatesh
Vidheya
V
Neonatal intensive Care Unit, Rosie Hospital, Cambridge, UK. vidheya.venkatesh@addenbrookes.nhs.uk
Ponnusamy
Vennila
V
Anandaraj
Juliet
J
Chaudhary
Rajiv
R
Malviya
Manish
M
Clarke
Paul
P
Arasu
Anusha
A
Curley
Anna
A
D000759:Adjuvants, Anesthesia / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000009:adverse effects; D001285:Atropine / Q000009:adverse effects; D001919:Bradycardia / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009020:Morphine / Q000009:adverse effects; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D011292:Premedication / Q000009:adverse effects*; D011446:Prospective Studies; D013390:Succinylcholine / Q000009:adverse effects
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D009467:Neuromuscular Depolarizing Agents; D009020:Morphine; D001285:Atropine; D013390:Succinylcholine; D010100:Oxygen