The effectiveness of premedication for endotracheal intubation in mechanically ventilated neonates. A systematic...

Area of Science:

• Neonatal medicine
• Pediatric critical care
• Anesthesiology

Background:

• Neonatal intubation is a common procedure.
• Current practices for neonatal intubation may not adequately address pain and physiological stress.
• Limited evidence exists on the optimal approach for neonatal intubation.

Purpose of the Study:

• To evaluate the appropriateness of awake intubation in neonates.
• To recommend best practices for neonatal intubation, including the role of premedication.
• To highlight areas for future research in neonatal intubation.

Main Methods:

• Review and extrapolation of data from adult and pediatric intubation literature.
• Analysis of the physiological effects of premedication on intubation responses.
• Consideration of the expertise required for neonatal intubation procedures.

Main Results:

• Awake intubation is likely inappropriate for the majority of neonates.
• Premedication is recommended to mitigate physiological responses during intubation.
• Neonatal intubation requires skilled practitioners with comprehensive knowledge of interventions.

Conclusions:

• Neonatal intubation should generally not be performed while the infant is awake.
• The use of premedication is advised to attenuate adverse physiological responses.
• Future research should focus on randomized controlled trials evaluating premedicated intubation in neonates, incorporating valid pain assessment and comprehensive outcome measures.