• Vidheya Venkatesh, Vennila Ponnusamy, Juliet Anandaraj, Rajiv Chaudhary, Manish Malviya, Paul Clarke, Anusha Arasu, and Anna Curley.
• Neonatal intensive Care Unit, Rosie Hospital, Cambridge, UK. vidheya.venkatesh@addenbrookes.nhs.uk
• Eur. J. Pediatr. 2011 Feb 1; 170 (2): 223-7.

IntroductionThere has been a significant increase in premedication use for neonatal intubation in the UK over the past decade. We aimed to determine the adverse events during neonatal intubation using the most commonly used premedication regimen in the UK.DiscussionWe prospectively studied all intubations performed using morphine, suxamethonium and atropine during a 3-month period in three UK tertiary neonatal units. Premedication was administered for 87/93 (94%) of intubations. Median time taken to prepare premedication was 16 min (IQR 10-35). Median time to successful intubation was 5 min (IQR 2-9) following premedication. Median lowest recorded oxygen saturation after administration of premedication was 65% (IQR 39-85). A bradycardia in the range 61-99/min accompanied the procedure in 24/93 (26%) intubations, with a median duration of bradycardia of 8 s (IQR 1-10).ConclusionDespite the widespread move to premedication for neonatal intubation, many deficiencies in everyday practice remain. The rate of haemodynamic complications is high in this commonly used premedication regimen. This study shows that there are important factors to control at the local level in terms of timely preparation and administration of premedication drugs, training and supervision of staff carrying out this high-risk procedure.

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