title: Ketamine and atropine decrease pain for preterm newborn tracheal intubation in the delivery room: an observational pilot study.
abstract: OBJECTIVE
  Various analgesic strategies are used before tracheal intubation of preterm newborns in the delivery room, due to the lack of a standard protocol and difficult venous access. This study evaluated the feasibility and efficacy of short venous catheter insertion and immediate ketamine analgesia for tracheal intubation of preterm newborns at birth in the delivery room.
  
  
  METHODS
  Prospective observational pilot study, with ketamine and atropine used at the paediatrician's discretion. Pain score, heart rate, SpO2 nadirs, procedure duration and neonatal intensive care unit morbidity were recorded.
  
  
  RESULTS
  Fifty-seven consecutive preterm newborns were included between January I and June 30, 2012: 15 in the no analgesia group and 39 in the intravenous ketamine group. Short catheter insertion failed in three newborns. The pain score was lower during laryngoscopy in the ketamine group (4 ± 0.7 vs. 2.9 ± 3.2 in the no analgesia group, p < 0.001). The heart rate nadir during tracheal intubation was 150.7 ± 29.6 bpm (vs. 112.6 ± 35.5 bpm in the no analgesia group, p < 0.01). Surfactant therapy was administered to 79.5% of newborns in the ketamine group (vs. 92.3%, p = 0.29) in the first 30 min of life.
  
  
  CONCLUSIONS
  Short venous catheter insertion with immediate ketamine analgesia plus atropine for tracheal intubation of preterm newborns in the delivery room was effective in decreasing pain and preventing vagal bradycardia.
authors.affiliation: Médecine et Réanimation Néonatale, CH Valenciennes, Valenciennes, France.
authors.forename: J
authors.initials: J
authors.lastname: Barois
authors.forename: P
authors.initials: P
authors.lastname: Tourneux
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D000700:Analgesics / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D002406:Catheterization, Peripheral; D003696:Delivery Rooms; D005240:Feasibility Studies; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D007649:Ketamine / Q000008:administration & dosage; D010865:Pilot Projects; D011446:Prospective Studies
chemical_list: D000700:Analgesics; D001285:Atropine; D007649:Ketamine
keywords: Airway management; Anaesthesia; Analgesia; Hospitals; Intensive care units; Maternity; Neonatal; Newborn infants