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Am J Perinatol 2025; 42(12): 1622-1629
DOI: 10.1055/a-2521-1118
Original Article

The Use of Premedication for Intubating Very Low Birth Weight Infants in the Neonatal Intensive Care Unit: Results of a National Survey

Cassandra DeMartino    *
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut
,
Sara Neches   *
2   Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington
,
Megan M. Gray 
2   Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington
,
Taylor Sawyer
2   Department of Pediatrics, Division of Neonatology, University of Washington School of Medicine, Seattle, Washington
,
Lindsay Johnston
1   Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Yale University School of Medicine, New Haven, Connecticut
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Funding None.
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Abstract

Objective

This study aimed to explore barriers and perspectives of premedication use for non-emergent intubations of very low birth weight (VLBW) infants (<1,500 g).

Study Design

A cross-sectional, online survey was distributed from January to April 2023 to members of the American Academy of Pediatrics Section on Neonatal-Perinatal Medicine. Data was analyzed using descriptive statistics and chi-square tests.

Results

Of the 521 respondents, the majority (81%, n = 415) were neonatologists. Over half of respondents (69%, n = 359) consider patient weight when selecting premedication. Most providers (78%, n = 407) agreed that premedication should be used for non-emergent intubation of VLBW infants, while only 41% (n = 216) felt similarly that muscle relaxants should be used. For infants over 1,500 g, 43% (n = 153) reported frequent or regular muscle relaxant use compared with 28% (n = 101) for VLBW infants. The most cited barrier to muscle relaxant use was surfactant delivery with a planned return to non-invasive support. Unit guidelines were associated with significantly more premedication and muscle relaxant use (56 vs. 44%; odds ratio [OR] = 5.2, 95% confidence interval [CI]: 3.4–7.7, p < 0.0001).

Conclusion

Most neonatal providers favor premedication for non-emergent intubation but are hesitant to use muscle relaxants for VLBW infants. Premedication guidelines may facilitate the use of both premedication and muscle relaxants for this population.

Key Points

  • Study of intubation premedication perceptions and practices for VLBW infants.

  • Premedication is used less for intubation of VLBW infants compared to their larger peers.

  • Unit premedication guidelines and available intubation backup may facilitate premedication use.

Keywords

neonatal intubation - premedication - muscle relaxants - very low birth weight

Authors' Contributions

C.D. and S.N. developed the study concept, designed and edited the survey, and wrote the original draft of the manuscript. S.N. also provided the statistical analysis. M.G., T.S., and L.J. edited and reviewed the survey and manuscript.


Ethical Approval

This study was performed in accordance with the Declaration of Helsinki and was approved with expedited review by the Yale University Institutional Review Board (IRB no.: 2000033633).


Declaration of Generative AI and AI-Assisted Technologies in the Writing Process

During the preparation of this work, the authors used ChatGPT to improve the readability and language of this manuscript. After using this tool/service, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication.


* These authors contributed equally to this work.




Publication History

Received: 24 September 2024

Accepted: 20 January 2025

Accepted Manuscript online:
21 January 2025

Article published online:
10 February 2025

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