• Xavier Durrmeyer, Patrick Daoud, Fabrice Decobert, Pascal Boileau, Sylvain Renolleau, Elodie Zana-Taieb, Carole Saizou, Alexandre Lapillonne, Michèle Granier, Philippe Durand, Richard Lenclen, Anne Coursol, Muriel Nicloux, Laure de Saint Blanquat, Rebecca Shankland, Pierre-Yves Boëlle, and Ricardo Carbajal.
• Inserm U953, Université Pierre et Marie Curie, Paris VI, France. xavier.durrmeyer@chicreteil.fr
• Pediatr Crit Care Me. 2013 May 1;14(4):e169-75.

ObjectivesTo describe the frequency and nature of premedications used prior to neonatal endotracheal intubation; to confront observed practice with current recommendations; and to identify risk factors for the absence of premedication.Design, Setting, And PatientsData concerning intubations were collected prospectively at the bedside as part of an observational study collecting around-the-clock data on all painful or stressful procedures performed in neonates during the first 14 days of their admission to 13 tertiary care units in the region of Paris, France, between 2005 and 2006.InterventionObservational study.Measurements And Main ResultsSpecific premedication prior to endotracheal intubation was assessed. Ninety one intubations carried out on the same number of patients were analyzed. The specific premedication rate was 56% and included mostly opioids (67%) and midazolam (53%). Compared with recent guidance from the American Academy of Pediatrics, used premedications could be classified as "preferred" (12%), "acceptable" (18%), "not recommended" (27%), and "not described" (43%). In univariate analysis, infants without a specific premedication compared with others were younger at the time of intubation (median age: 0.7 vs. 2.0 days), displayed significantly more frequent spontaneous breathing at the time of intubation (31% vs. 12%) and a higher percentage of analgesia for all other painful procedures (median values: 16% vs. 6%). In multivariate analysis, no factor remained statistically significant.ConclusionsPremedication use prior to neonatal intubation was not systematically used and when used it was most frequently inconsistent with recent recommendations. No patient- or center-related independent risk factor for the absence of premedication was identified in this study.

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