Association of full premedication on tracheal intubation outcomes in the neonatal intensive care unit: an observational cohort study

Objective: Evaluate the association of short-term tracheal intubation (TI) outcomes with premedication in the NICU. Study Design: Observational single-center cohort study comparing TIs with full premedication (opiate analgesia and vagolytic and paralytic), partial premedication, and no premedication. The primary outcome is adverse TI associated events (TIAEs) in intubations with full premedication compared to those with partial or no premedication. Secondary outcomes included change in heart rate and first attempt TI success. Results: 352 encounters in 253 infants (median gestation 28 weeks, birth weight 1100g) were analyzed. TI with full premedication was associated with fewer TIAEs aOR 0.26 (95%CI 0.1-0.6) compared with no premedication, and higher first attempt success aOR 2.7 (95%CI 1.3-4.5) compared with partial premedication after adjusting for patient and provider characteristics. Conclusion: The use of full premedication for neonatal TI, including an opiate, vagolytic, and paralytic, is associated with fewer adverse events compared with no and partial premedication.