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Haemodynamic effects of premedication for neonatal intubation: an observational study
  1. Linda Truong1,
  2. Jae H Kim2,3,
  3. Anup C Katheria4,
  4. Neil N Finer2,
  5. Krishelle Marc-Aurele2,3
  1. 1 Department of Pediatrics, Division of Neonatal-Developmental Medicine, Stanford University, Palo Alto, California, USA
  2. 2 Department of Pediatrics, Division of Neonatology, University of California San Diego Health System, San Diego, California, USA
  3. 3 Department of Pediatrics, Division of Neonatology, Rady Children’s Hospital of San Diego, San Diego, California, USA
  4. 4 Neonatology, Sharp Mary Birch, San Diego, California, USA
  1. Correspondence to Dr Linda Truong, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Palo Alto CA 94304, USA; ltruong524{at}


Objective To examine changes in blood pressure (BP), cardiac output (CO) and cerebral regional oxygen saturation (rScO2) with administration of premedication for neonatal intubation.

Design Pilot, prospective, observational study. Oxygen saturation, heart rate, CO, rScO2 and BP data were collected. Monitoring began 5 min prior to premedication and continued until spontaneous movement.

Setting Single-centre, level 3 neonatal intensive care unit

Patients 35 infants, all gestational ages. 81 eligible infants: 66 consented, 15 refused.

Interventions Intravenous atropine, fentanyl or morphine, ±cisatracurium

Main outcome measures BP, CO, rScO2

Results n=37 intubations. Mean gestational age and median birth weight were 31 4/7 weeks and 1511 g. After premedication, 10 episodes resulted in a BP increase from baseline and 27 in a BP decrease. Of those whose BP decreased, 17 had <20% decrease and 10 had ≥20% decrease. Those with <20% BP decrease took an average of 2.5 min to return to baseline while those with a ≥20% BP decline took an average of 15.2 min. Three did not return to baseline by 35 min. Following intubation, further declines in BP (21%–51%) were observed in eight additional cases. One infant required a bolus for persistently low BPs. CO and rScO2 changes were statistically similar between the two groups.

Conclusion About 30% of infants dropped their BP by ≥20% after premedication for elective intubation. These BP changes were not associated with any significant change in rScO2 or CO. More data are needed to better characterise the immediate haemodynamic changes and clinical outcomes associated with premedication.

  • neonatology
  • hemodynamic
  • blood pressure
  • premedication
  • intubation

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  • Contributors All authors contributed to the original scientific design of the study as well as revising drafts critically for important intellectual content. LT and KM-A were responsible for the analysis, interpretation of data collected and final version published.

  • Competing interests None declared.

  • Ethics approval This study was reviewed and approved by the Institutional Review Board of the University of California, San Diego.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Haemodynamics data of individual patients are available to LT and KM-A from the time the study was originally conducted. Summary and analysis of the data are provided in the manuscript.

  • Patient consent for publication Not required.

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