Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events

Yuri Ozawa, Anne Ades, Elizabeth E Foglia, Stephen DeMeo, James Barry, Taylor Sawyer, Neetu Singh, Kristen Glass, Philipp Jung, Bin Huey Quek, Lindsay Johnston, Jae Kim, Natalie Napolitano, Justine Shults, Vinay M Nadkarni, Akira Nishisaki
Journal of Perinatology: Official Journal of the California Perinatal Association 2019, 39 (6): 848-856

OBJECTIVE: To determine the impact of premedication for tracheal intubation (TI) on adverse TI associated events, severe oxygen desaturations, and first attempt success STUDY DESIGN: Retrospective cohort study in neonatal intensive care units (NICU) participating in the National Emergency Airway Registry for Neonates from 10/2014 to 6/2017. Premedication for TI was categorized as sedation with neuromuscular blockade, sedation only, or no medication.

RESULTS: 2260 TIs were reported from 11 NICUs. Adverse TI associated events occurred less often in sedation with neuromuscular blockade group (10%) as compared to sedation only (29%), or no medication group (23%), p < 0.001. The adjusted odds ratio (aOR) for adverse TI associated events were: sedation with neuromuscular blockade aOR 0.48 (95%CI 0.34-0.65, p < 0.001) compared to no medication.

CONCLUSION: Use of sedation with neuromuscular blockade was associated with favorable TI outcomes. This study supports the recommendation for the standard use of sedation with neuromuscular blockade in non-emergency TIs.

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