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Association of full premedication on tracheal intubation outcomes in the neonatal intensive care unit: an observational cohort study



Evaluate the association of short-term tracheal intubation (TI) outcomes with premedication in the NICU.

Study design

Observational single-center cohort study comparing TIs with full premedication (opiate analgesia and vagolytic and paralytic), partial premedication, and no premedication. The primary outcome is adverse TI associated events (TIAEs) in intubations with full premedication compared to those with partial or no premedication. Secondary outcomes included change in heart rate and first attempt TI success.


352 encounters in 253 infants (median gestation 28 weeks, birth weight 1100 g) were analyzed. TI with full premedication was associated with fewer TIAEs aOR 0.26 (95%CI 0.1–0.6) compared with no premedication, and higher first attempt success aOR 2.7 (95%CI 1.3–4.5) compared with partial premedication after adjusting for patient and provider characteristics.


The use of full premedication for neonatal TI, including an opiate, vagolytic, and paralytic, is associated with fewer adverse events compared with no and partial premedication.

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Fig. 1: Flow diagram.
Fig. 2: Univariate outcomes according to premedication group.
Fig. 3: Multivariate analysis of primary and secondary outcomes comparing three premedication groups.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.


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We would like to thank the pediatric residents, neonatal fellows, advance practice providers, and attending neonatologists at the University of Washington Medical Center, Montlake NICU, for their timely completion of the NEAR4NEOS data collection forms. We also extend thanks to Hayley Buffman at the Children’s Hospital of Philadelphia for her commitment to neonatal intubation safety and maintenance of the NEAR4NEOS database.

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Authors and Affiliations



SKN was responsible for study concept, data form auditing, extracting, and analyzing data, interpretation of results, and report writing. BKB was responsible for unit protocol changes, data form auditing, and report edits. RU contributed to the interpretation of results and provided feedback on the report. MMG guided with statistical analysis and presentation of data and provided feedback on the report. TS provided feedback on the report and AN and EF were responsible for generating the NEAR4NEOS centralized repository for neonatal intubation safety data and provided feedback on the report.

Corresponding author

Correspondence to Sara K. Neches.

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Competing interests

The authors have no financial disclosures or conflicts of interest. NEAR4NEOS has been supported by NICHD HD089151. There was no direct funding for this analysis.

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Neches, S.K., Brei, B.K., Umoren, R. et al. Association of full premedication on tracheal intubation outcomes in the neonatal intensive care unit: an observational cohort study. J Perinatol 43, 1007–1014 (2023).

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