title: Intubation in the delivery room: experience with nasal midazolam.
abstract: BACKGROUND
  Neonates are often intubated in the delivery room (DR) without anesthesia because vascular access is impossible.
  
  
  OBJECTIVE
  To assess neonatal comfort and adverse events after use of nasal midazolam (nMDZ) for intubation in the DR.
  
  
  METHODS
  Prospective data collection over 6months on the intubation of neonates with respiratory distress requiring tracheal instillation of surfactant.
  
  
  METHODS
  Twenty-seven neonates with median (Q25-75) gestational age and birthweight of, respectively, 29 (27-33)weeks and 1270 (817-1942)g received a 0.1mg/kg dose of nMDZ, and intubation was performed at the onset of tonus resolution or apnea.
  
  
  METHODS
  Comfort was assessed with a scale of hetero-pain assessment and electrical skin conductance monitoring. Continuous pulse oximetry was recorded in the first postnatal hour, with oscillometric blood pressure measurement every 10min.
  
  
  RESULTS
  Seventy percent of the patients required a single dose, with intubation performed 4.8 (3-9)min after administration. Combined electro-clinical assessment found adequate comfort during the procedure in 68% of neonates. Mean blood pressure decreased from 39 (34-44)mmHg before to 31 (25-33)mmHg 1h following nMDZ (p=0.011).
  
  
  CONCLUSIONS
  nMDZ provided rapid and effective sedation to intubate neonates in the DR but potentially exposed them to hypotension, thus requiring close hemodynamic monitoring.
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Julien
authors: J
authors: Baleine
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Christophe
authors: C
authors: Milési
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Renaud
authors: R
authors: Mesnage
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Aline
authors: A
authors: Rideau Batista Novais
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Clémentine
authors: C
authors: Combes
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France.
authors: Sabine
authors: S
authors: Durand
authors: Neonatal Intensive Care Unit, Department of Pediatrics, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, 34000 Montpellier, France. Electronic address: g-cambonie@chu-montpellier.fr.
authors: Gilles
authors: G
authors: Cambonie
mesh_terms: D000281:Administration, Intranasal; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D007231:Infant, Newborn; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam
keywords: CPAP; Comfort; DR; Delivery room; FANS; GA; Intubation; MABP; Midazolam; NICU; Nasal mucosa; Newborn; RTC scale; continuous positive airway pressure; delivery room; faceless acute neonatal pain scale; gestational age; mean arterial blood pressure; nMDZ; nasal midazolam; neonatal intensive care unit; reactivity, tonus and consciousness scale