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

Journal of Perinatology volume 39, pages 848–856 (2019)Cite this article

Subjects

Abstract

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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Acknowledgements

We thank the NEAR4NEOS team and data coordinators at each participating site for their time, effort, and commitment. We thank Hayley Buffman, MPH and Stephanie Tuttle, MBA for their administrative support.

Funding

The current study is supported by NICHD 1R21HD089151. Drs. Ades, Sawyer, and Nishisaki and Ms. Napolitano are supported by NICHD 1R21HD089151. Dr. Nishisaki and Ms. Napolitano is supported by AHRQ 1R18HS024511.

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Authors and Affiliations

  1. Center for simulation, Advanced Education and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Yuri Ozawa, Anne Ades, Vinay M. Nadkarni & Akira Nishisaki

  2. Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Anne Ades & Elizabeth E. Foglia

  3. Department of Pediatrics, WakeMed Health and Hospital, Raleigh, Campus NC, USA

    Stephen DeMeo

  4. Division of Neonatology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO, USA

    James Barry

  5. Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA

    Taylor Sawyer

  6. Division of Neonatology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, NH, USA

    Neetu Singh

  7. Division of Neonatology, Department of Pediatrics, Penn State Health Children’s Hospital/Penn State College of Medicine, Hershey, PA, USA

    Kristen Glass

  8. Department of Pediatrics, University Hospital Schleswing-Holstein, Campus Luebeck, Luebeck, Germany

    Philipp Jung

  9. Neonatology Department, KK Women’s and Children’s Hospital, Singapore, Singapore

    Bin Huey Quek

  10. Division of Neonatology, Yale University School of Medicine, New Haven, CT, USA

    Lindsay Johnston

  11. Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA

    Jae Kim

  12. Respiratory Therapy Department, The Children’s Hospital of Philadelphia PA, Philadelphia, PA, USA

    Natalie Napolitano

  13. Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA

    Justine Shults

  14. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Vinay M. Nadkarni & Akira Nishisaki

Authors
  1. Yuri Ozawa
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  2. Anne Ades
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  3. Elizabeth E. Foglia
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  9. Philipp Jung
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  13. Natalie Napolitano
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  15. Vinay M. Nadkarni
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  16. Akira Nishisaki
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for the National Emergency Airway Registry for Neonates (NEAR4NEOS) Investigators

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Correspondence to Yuri Ozawa.

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Ozawa, Y., Ades, A., Foglia, E.E. et al. Premedication with neuromuscular blockade and sedation during neonatal intubation is associated with fewer adverse events. J Perinatol 39, 848–856 (2019). https://doi.org/10.1038/s41372-019-0367-0

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