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



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.


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.


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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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.


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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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).

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