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

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..