Premedication practices for neonatal tracheal intubation: Results from the EPIPPAIN 2 prospective cohort study and comparison with EPIPPAIN 1

To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning...

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Bibliographic Details
Published in:	Paediatric and neonatal pain Vol. 3; no. 2; pp. 46 - 58
Main Authors:	Walter‐Nicolet, Elizabeth, Marchand‐Martin, Laetitia, Guellec, Isabelle, Biran, Valérie, Moktari, Mostafa, Zana‐Taieb, Elodie, Magny, Jean‐François, Desfrère, Luc, Waszak, Paul, Boileau, Pascal, Chauvin, Gilles, Saint Blanquat, Laure, Borrhomée, Suzanne, Droutman, Stéphanie, Merhi, Mona, Zupan, Véronique, Karoui, Leila, Cimerman, Patricia, Carbajal, Ricardo, Durrmeyer, Xavier
Format:	Journal Article
Language:	English
Published:	United States John Wiley & Sons, Inc 01-06-2021 John Wiley and Sons Inc Wiley
Subjects:	Analgesics Anesthesia Birth weight Drugs Epidemiology evidence‐based practice Intensive care Intubation neonate Original Research Original Researches pain Pain management Patients Pediatrics premedication tracheal intubation France evidence‐based practice pain neonate tracheal intubation premedication
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Summary:	To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning TI performed in neonates during the first 14 days of their admission to participating neonatal/pediatric intensive care units were prospectively collected at the bedside. This study was part of the Epidemiology of Procedural Pain in Neonates study (EPIPPAIN 2) conducted in 16 tertiary care units in the region of Paris, France, in 2011. Multivariate analysis was used to identify factors associated with premedication use and multilevel analysis to identify center effect. Results were compared with those of the EPIPPAIN 1 study, conducted in 2005 with a similar design, and to a current guidance for the clinician for this procedure. One hundred and twenty‐one intubations carried out in 121 patients were analyzed. The specific premedication rate was 47% and drugs used included mainly propofol (26%), sufentanil (24%), and ketamine (12%). Three factors were associated with the use of a specific premedication: nonemergent TI (Odds ratio (OR) [95% CI]: 5.3 [1.49‐20.80]), existence of a specific written protocol in the ward (OR [95% CI]:4.80 [2.12‐11.57]), and the absence of a nonspecific concurrent analgesia infusion before TI (OR [95% CI]: 3.41 [1.46‐8.45]). No center effect was observed. The specific premedication rate was lower than the 56% rate observed in 2005. The drugs used were more homogenous and consistent with the current recommendations than in 2005, especially in centers with a specific written protocol. Premedication use prior to neonatal TI was low, even for nonemergent procedures. Scientific consensus, implementation of international or national recommendations, and local written protocols are urgently needed to improve premedication practices for neonatal intubation.
Bibliography:	Funding information This study was supported by a grant from the CNP Foundation (Caisse Nationale de Prevoyance‐Assurances, Paris, France) and a grant from the Programme Hospitalier de Recherche Clinique Regional (PHRC regional) 2012 with the file number 136. The main author received a financial contribution from the Apicil Foundation (Fondation Apicil, Lyon, France) to carry out a master's degree ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2637-3807 2637-3807
DOI:	10.1002/pne2.12048