Premedication before intubation in UK neonatal units

Area of Science:

• Neonatal Medicine
• Pediatric Anesthesiology
• Clinical Pharmacology

Background:

• Neonatal intubation is a common procedure associated with significant physiological stress.
• Premedication with sedatives and analgesics can mitigate this stress and improve intubation success.
• Current practices regarding premedication in UK neonatal units are not well-documented.

Purpose of the Study:

• To determine the prevalence and types of premedication administered before endotracheal intubation in UK neonatal intensive care units (NICUs).
• To identify variations in premedication protocols and the existence of written guidelines.

Main Methods:

• A structured telephone survey was administered to 241 eligible neonatal units across the UK.
• Units were categorized into those performing routine intubations and those transferring intubated neonates.
• Data on premedication drugs, dosages, and policy documentation were collected.

Main Results:

• A high response rate (99%) was achieved, with 239 units participating.
• Only 37% of units reported using any sedation before intubation, and only 14% had a written policy.
• Morphine was the most common agent (66%), with significant variability in drug doses (up to 200-fold differences).

Conclusions:

• A majority of UK neonatal units do not routinely sedate infants prior to intubation, contrary to evidence supporting its benefits.
• The lack of written guidelines hinders consistent practice and quality improvement efforts in neonatal intubation.
• There is a need to standardize and improve premedication practices for neonatal intubation in the UK.