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Premedication with paralysis improves intubation success and decreases adverse events in very low birth weight infants: a prospective cohort study

Journal of Perinatology volume 38, pages 681–686 (2018)Cite this article

Subjects

Abstract

Objective

To characterize the impact of premedication with and without a paralytic agent on the safety of tracheal intubation (TI) in infants ≤1500 g.

Study design

A prospective observational cohort study between February 2015 and June 2017. The primary outcomes were associations between the use of different premedication regimens with number of TI attempts, TI adverse events (TIAEs), and changes in heart rate.

Results

Data were collected on 237 TIs. Median postmenstrual age at intubation was 28 completed weeks and weight was 953 g. Premedication with a paralytic was associated with fewer intubation attempts compared to premedication without a paralytic (p = 0.037). Premedication with a paralytic was associated with fewer TIAEs (p < 0.001) and less bradycardia compared to the other two regimens (p = 0.003) compared to premedication without a paralytic.

Conclusions

Premedication with a paralytic was associated with fewer intubation attempts, fewer TIAEs, and less bradycardia. Premedication with a paralytic may improve intubation safety in VLBWs.

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Acknowledgements

We would like to thank the neonatal fellows, attendings, nurse practitioners, hospitalists, and physician assistants in the NICUs at the University of Washington Medical Center and Seattle Children’s Hospital for their diligent completion of NEAR4NEOS data collection forms. We would also like to thank Hayley Buffman, Natalie Napolitano, and Akira Nishisaki at Children’s Hospital of Philadelphia for their work with the NEAR4NEOs database.

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Authors and Affiliations

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

    Jeanne Krick, Megan Gray, Rachel Umoren, Gina Lee & Taylor Sawyer

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  1. Jeanne Krick
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  2. Megan Gray
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  3. Rachel Umoren
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Correspondence to Jeanne Krick.

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The authors have no conflicts of interest relevant to this article to disclose.

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Krick, J., Gray, M., Umoren, R. et al. Premedication with paralysis improves intubation success and decreases adverse events in very low birth weight infants: a prospective cohort study. J Perinatol 38, 681–686 (2018). https://doi.org/10.1038/s41372-018-0082-2

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