Editor—The paper by Bhutadaet al 1 adds to the growing body of evidence that premedication for tracheal intubation in neonates both improves physiological stability and makes the procedure easier to perform. The results of the telephone survey of premedication use in UK neonatal units by Whyte et al 2helps to define current practice. In a similar study, we recently tried to define the routine use of premedication for tracheal intubation in term and preterm neonates in Australia and the United Kingdom, allowing comparisons to be made.

A survey was conducted of practice in Australian level 3 units (21) and UK units with six or more intensive care cots (52). The format was a semistructured telephone interview of the nurse in charge of the shift when the call was made. All interviews were conducted by one of two of the authors (S H and J B) in September 1999. There was a 100% response rate, and the results are given in table 1.

Seven different combinations of premedication drugs were in routine use in Australia compared with 14 different combinations in the United Kingdom.

In Australian units, the routine administration of premedication for non-emergency tracheal intubation of term and preterm neonates is common practice, and there is some uniformity in the combinations of drugs used. In contrast, this practice is less common in the United Kingdom and there is more diversity of prescribing. In both countries, premedication was more commonly used for term neonates. This difference in practice may reflect the fact that larger babies are more likely to struggle when intubated, making the procedure more technically demanding.

We agree with Whyte et al that there is a strong evidence based argument for premedication for tracheal intubation in neonates to be routine. Our work brings added clarity to the existing picture and confirms that there is little consensus as to the best combination of drugs to use. Further work to define best practice is urgently required.