Premedication Use Before Nonemergent Intubation in the Newborn Infant

In 2010, an American Academy of Pediatrics (AAP) clinical report recommended that except for emergent situations, premedication should be used for all endotracheal intubations in newborns. The purpose of this study is to ascertain the current practice of premedication before elective intubation.

An online, survey-based questionnaire on the practice of premedication before nonemergent intubations was distributed via e-mail to neonatologists who are members of the Perinatal Section of the AAP.

Although 72% of respondents believed premedication should be used in nonemergent intubations, only 34% of the respondents report frequently premedicating before intubation with significant variation among the neonatal units (46% among level 4 units and 27% in level 3 and 2 units) p = 0.000. About 44% of respondents report having a written protocol or guideline on premedication which significantly correlated with the use of premedication (62% in level 4, 33% in level 3, and 16% in level 2 units), p = 0.000.

Despite a recent AAP clinical report recommending the use of premedication before nonemergent endotracheal intubation, only one-third of neonatologists report frequent use of premedication and less than half of the institutions have a written protocol on premedication.