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

doi:10.1038/s41372-019-0367-0

Multicenter Study

. 2019 Jun;39(6):848-856.

doi: 10.1038/s41372-019-0367-0. Epub 2019 Apr 2.

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

Yuri Ozawa¹, Anne Ades^{2

3}, Elizabeth E Foglia³, Stephen DeMeo⁴, James Barry⁵, Taylor Sawyer⁶, Neetu Singh⁷, Kristen Glass⁸, Philipp Jung⁹, Bin Huey Quek¹⁰, Lindsay Johnston¹¹, Jae Kim¹², Natalie Napolitano¹³, Justine Shults¹⁴, Vinay M Nadkarni^{2

15}, Akira Nishisaki^{2

15}; National Emergency Airway Registry for Neonates (NEAR4NEOS) Investigators

Affiliations

¹ Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. yuri-nishi@hotmail.com.
² Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Department of Pediatrics, WakeMed Health and Hospital, Raleigh, Campus NC, USA.
⁵ Division of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁶ Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
⁷ Division of Neonatology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, NH, USA.
⁸ Division of Neonatology, Department of Pediatrics, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, PA, USA.
⁹ Department of Pediatrics, University Hospital Schleswing-Holstein, Campus Luebeck, Luebeck, Germany.
¹⁰ Neonatology Department, KK Women's and Children's Hospital, Singapore, Singapore.
¹¹ Division of Neonatology, Yale University School of Medicine, New Haven, CT, USA.
¹² Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
¹³ Respiratory Therapy Department, The Children's Hospital of Philadelphia PA, Philadelphia, PA, USA.
¹⁴ Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
¹⁵ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 30940929
DOI: 10.1038/s41372-019-0367-0

Multicenter Study

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

Yuri Ozawa et al. J Perinatol. 2019 Jun.

. 2019 Jun;39(6):848-856.

doi: 10.1038/s41372-019-0367-0. Epub 2019 Apr 2.

Authors

Affiliations

¹ Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. yuri-nishi@hotmail.com.
² Center for simulation, Advanced Education and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
³ Division of Neonatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Department of Pediatrics, WakeMed Health and Hospital, Raleigh, Campus NC, USA.
⁵ Division of Neonatology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
⁶ Division of Neonatology, Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA, USA.
⁷ Division of Neonatology, Department of Pediatrics, Dartmouth Hitchcock Medical Center, West Lebanon, NH, USA.
⁸ Division of Neonatology, Department of Pediatrics, Penn State Health Children's Hospital/Penn State College of Medicine, Hershey, PA, USA.
⁹ Department of Pediatrics, University Hospital Schleswing-Holstein, Campus Luebeck, Luebeck, Germany.
¹⁰ Neonatology Department, KK Women's and Children's Hospital, Singapore, Singapore.
¹¹ Division of Neonatology, Yale University School of Medicine, New Haven, CT, USA.
¹² Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA, USA.
¹³ Respiratory Therapy Department, The Children's Hospital of Philadelphia PA, Philadelphia, PA, USA.
¹⁴ Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
¹⁵ Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 30940929
DOI: 10.1038/s41372-019-0367-0

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

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

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