title: [Implementation of a specific premedication protocol for tracheal intubation in the delivery room. Practice in two level-III hospitals].
abstract: Tracheal intubation in neonates is a painful procedure performed daily in the delivery room despite the widespread development of noninvasive ventilation. Specific analgesia is not commonly performed. The objective of this observational study was to compare practices between two level-III centers: one with a specific protocol for premedication before tracheal intubation of newborns in the delivery room, the other without.
  
  
  RESULTS
  One hundred and fifteen neonates were intubated in the delivery room and included over a 4-month period: 25% of them received specific premedication before intubation, exclusively in the center with the protocol. None of the extreme premature neonates (age≤28 gestational weeks) received analgosedation before the procedure. Nalbuphine, midazolam, and sufentanil were mainly used, via the intravenous or intrarectal route. Infants receiving a premedication were significantly heavier and had a greater gestational age than the others (1500 g [range, 1180-2260 g] vs. 1170 [range, 860-1680 g] P=0.003, and 31 GW [range, 29-34 GW] vs. 29 [range, 27-32 GW] P=0.014, respectively). Most pediatricians (85-100%) favored a specific protocol for sedation before tracheal intubation. Implementation of a specific protocol allows specific analgesia to be implemented for newborns undergoing tracheal intubation. Further studies should be conducted to determine the best strategies for pain management during tracheal intubation of neonates, especially in the delivery room.
authors.affiliation: Service de néonatologie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France; Service de néonatologie, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France. Electronic address: ewalter@hpsj.fr.
authors.forename: E
authors.initials: E
authors.lastname: Walter-Nicolet
authors.affiliation: Service de gynécologie-obstétrique, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Zanichelli
authors.affiliation: Service de néonatologie, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France.
authors.forename: S
authors.initials: S
authors.lastname: Coquery
authors.affiliation: Centre national de ressources contre la douleur, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Cimerman
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D001835:Body Weight; D002985:Clinical Protocols; D003696:Delivery Rooms; D005602:France; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D010146:Pain / Q000517:prevention & control*; D011292:Premedication; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy
chemical_list: D000700:Analgesics