Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates.
OBJECTIVE
A new guideline for the early respiratory management of preterm infants that included early nCPAP and INSURE was recently introduced in our NICU. This case series describes the clinical courses of a group of preterm infants managed according to this guideline, and reports the rates of successful extubation within 30 minutes of surfactant administration with and without the use of naloxone and adverse events encountered.


METHODS
Descriptive case series of all preterm babies admitted to our unit who were candidates for INSURE procedure with premedication from August 2012 to August 2013.


RESULTS
A total of 31 infants were included with a mean birth weight of 1178 grams and a mean gestational age of 28.4 weeks. Twelve out of thirteen (92%) infants in the naloxone group were extubated within 30 minutes of surfactant administration while only 12/18 (67%) in the non-naloxone group were extubated within the same time frame. No adverse reactions were noted with naloxone usage in this context.


CONCLUSIONS
Naloxone can be effective in reversing the respiratory depressive effect of analgesic premedication and in turn facilitates expeditious extubation in some preterm infants intubated for INSURE procedure.
Department of Paediatrics, Queen's University, Kingston, ON, Canada.|Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.
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Elmekkawi
Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.
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Abdelgadir
Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.|Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Van Dyk
Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Choudhury
Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.|Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Dunn
D000759:Adjuvants, Anesthesia / Q000627:therapeutic use; D060666:Airway Extubation / Q000379:methods; D000701:Analgesics, Opioid / Q000009:adverse effects*; D001285:Atropine / Q000627:therapeutic use; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007442:Intubation, Intratracheal / Q000379:methods; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009467:Neuromuscular Depolarizing Agents / Q000627:therapeutic use; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000188:drug therapy*; D013390:Succinylcholine / Q000627:therapeutic use
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009467:Neuromuscular Depolarizing Agents; D011663:Pulmonary Surfactants; D009270:Naloxone; D001285:Atropine; D013390:Succinylcholine; D005283:Fentanyl
Endotracheal intubation; INSURE; naloxone; newborn; premedication; preterm