title: Premedication for neonatal endotracheal intubation: results from the epidemiology of procedural pain in neonates study.
abstract: OBJECTIVE
  To describe the frequency and nature of premedications used prior to neonatal endotracheal intubation; to confront observed practice with current recommendations; and to identify risk factors for the absence of premedication.
  
  
  METHODS
  Data concerning intubations were collected prospectively at the bedside as part of an observational study collecting around-the-clock data on all painful or stressful procedures performed in neonates during the first 14 days of their admission to 13 tertiary care units in the region of Paris, France, between 2005 and 2006.
  
  
  METHODS
  Observational study.
  
  
  RESULTS
  Specific premedication prior to endotracheal intubation was assessed. Ninety one intubations carried out on the same number of patients were analyzed. The specific premedication rate was 56% and included mostly opioids (67%) and midazolam (53%). Compared with recent guidance from the American Academy of Pediatrics, used premedications could be classified as "preferred" (12%), "acceptable" (18%), "not recommended" (27%), and "not described" (43%). In univariate analysis, infants without a specific premedication compared with others were younger at the time of intubation (median age: 0.7 vs. 2.0 days), displayed significantly more frequent spontaneous breathing at the time of intubation (31% vs. 12%) and a higher percentage of analgesia for all other painful procedures (median values: 16% vs. 6%). In multivariate analysis, no factor remained statistically significant.
  
  
  CONCLUSIONS
  Premedication use prior to neonatal intubation was not systematically used and when used it was most frequently inconsistent with recent recommendations. No patient- or center-related independent risk factor for the absence of premedication was identified in this study.
authors: Inserm U953, Université Pierre et Marie Curie, Paris VI, France. xavier.durrmeyer@chicreteil.fr
authors: Xavier
authors: X
authors: Durrmeyer
authors: Patrick
authors: P
authors: Daoud
authors: Fabrice
authors: F
authors: Decobert
authors: Pascal
authors: P
authors: Boileau
authors: Sylvain
authors: S
authors: Renolleau
authors: Elodie
authors: E
authors: Zana-Taieb
authors: Carole
authors: C
authors: Saizou
authors: Alexandre
authors: A
authors: Lapillonne
authors: Michèle
authors: M
authors: Granier
authors: Philippe
authors: P
authors: Durand
authors: Richard
authors: R
authors: Lenclen
authors: Anne
authors: A
authors: Coursol
authors: Muriel
authors: M
authors: Nicloux
authors: Laure
authors: L
authors: de Saint Blanquat
authors: Rebecca
authors: R
authors: Shankland
authors: Pierre-Yves
authors: PY
authors: Boëlle
authors: Ricardo
authors: R
authors: Carbajal
mesh_terms: D000367:Age Factors; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008874:Midazolam / Q000627:therapeutic use*; D010146:Pain / Q000453:epidemiology / Q000209:etiology; D010297:Paris; D017410:Practice Guidelines as Topic; D011292:Premedication / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam