Endotracheal intubation in a neonatal population remains associated with a high risk of adverse events

Abstract

Despite 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.

Bradycardia during critical care intubation: mechanisms, significance and atropine: Figure 1

“…Atropine has a proven efficacy of reducing falls in heart rate in prospective ECG studies during routine anaesthesia of infants,81 small82 and older children and adolescents 8 68. In critical care settings a similar trend has been repeated in neonates69 83 and in one retrospective out-of-hospital study 18. However, another retrospective study of children in an emergency department showed a 4% rate of bradycardia with or without atropine 17…”

“…These are most frequently based on an absolute change in heart rate,64–66 but any bradycardic event,43 67 a fall below 2 SDs of the mean heart rate for age,17 three or more beats at <60 beats/min,68 69 at <100 beats/min69 70 or percentage reductions in base rate such as 20%8 or 25%,18 have also been proposed. Such non-agreement over any definition of what constitutes bradycardia during intubation inevitably obscures the true frequency of the event.…”

Colostomy in neonates under local anaesthesia: Indications, technique and outcome

“…[6,7] The stressful adverse events occurring in neonates following endotracheal intubation cannot be overemphasized. [8] Mortality is particularly increased in critical patients especially when the procedure is done under general anaesthesia. [9] This was perhaps due to stress of general anaesthesia in an already vulnerable neonate.…”

Neonatal airway practices: a telephone survey of all UK level 3 neonatal units

“…Capnography is standard adult practice and recommended by The Royal College of Anaesthetists and The Difficult Airway Society for every EI 3. Overall, performance of neonatal EI is poor with success rates being as low as 21% 4 5. Capnography for the confirmation of intubation success in neonates should be standard practice.…”