Premedication before intubation in UK neonatal units: A decade of Change?

Abstract

Aims: To ascertain the prevalence of premedication before intubation and the choice of drugs used in UK neonatal units in 2007 and assess changes in practice since 1998.

Methods: A structured telephone survey was performed of 221 eligible units. Of those units surveyed, 214 completed the telephone questionnaire. The units were subdivided into those that routinely intubated and ventilated neonates (routine group) and those that intubated neonates prior to transfer to a regional unit (transfer group). A similar study was performed by one of the authors in 1998. The same telephone methodology was used in this study.

Results: Premedication for newborn intubations was provided by 93% (198/214) of all UK units and 76% (162/214) had some written policy or guideline concerning premedication prior to elective intubations. Of those 198 units who premedicate, morphine was found to be the most widely used sedative for newborn intubations with 80% (158/198) using either morphine alone or in combination with other drugs. The most widely used combination was morphine and suxamethonium +/- atropine. This was used by 21% (41/198) of all units. A total of 78% (154/198) of all units administered a paralytic agent.

Conclusions: There has been a substantial increase in the number of UK neonatal units that provide some premedication for nonemergent newborn intubations over the last decade, from 37% in 1998 to 93% in 2007. This includes a concomitant increase in the use of paralytics from 22% to 78%. However, the variety of drugs used merits further research.