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