Nasal midazolam vs ketamine for neonatal intubation in the delivery room: a randomised trial
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  • Published on:
    • Subhash C Shaw, Neonatologist Dept of Pediatrics, Armed Forces Medical College, Pune 411040. India
    • Other Contributors:
      • Arjun Kurup, Resident
      • Kannan Venkatnarayan, Neonatologist

    Dear Editor,
    We read with great interest the article “Nasal midazolam vs ketamine for neonatal intubation in the delivery room: a randomised trial” by Milési et al published in Arch Dis Child Fetal Neonatal Ed 2018; 103: F221-F226.1 We complement the authors for this well conducted randomized trial on a very important subject of sedation while neonatal intubation. Having gone through the article, we would like to add the following.
    The intubations done were all non-emergent, with the mean gestational age being 27.6 (24-34) and 28.3 (24-36) weeks in both the groups respectively. It will be interesting to know what percentage of infants underwent Intubation, Surfactant administration, Extubation (INSURE)2 and placed back on nasal CPAP. As good respiratory drive is an essential prerequisite for nasal CPAP, there are concerns for sedation while attempting INSURE.
    The other concern is about the safety of both the drugs used in neonatal particularly in preterm population. There are reports of paradoxical stimulation of central nervous system including myoclonic movements associated with administration of midazolam.3 There is also evidence to suggest midazolam administration leading to increased NICU stay and adverse neurological events.4 The oscillometric blood pressure measurement recorded intermittently as in this study might not capture continuous invasive blood pressure changes.
    Finally, as the article very succinctly explained that the dosage of keta...

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    Conflict of Interest:
    None declared.