Premedication for neonatal intubation - current practice in Australia and the UK

Stephen Hancock, Paediatric Specialist Registrar,
April 26, 2000

The paper by Bhutada et 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 (2) helps to define current practice. In a similar study, we recently tried to define the routine use of premedication for tracheal intubation in term and pre-term neonates in Australia and the UK - allowing comparisons to be made.

A survey was conducted of practice in Australian level 3 units (21) and UK units with 6 or more intensive care cots (52). The format was a semi-structured 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 (SWH and JB) in September 1999.

There was a 100% response rate. Results were:

United Kingdom Australia
Term Pre-term Term Pre-term
Routine premedication (%) 22(42)  18(34) 15(71)  14(67)
Opiate 13  11  2 4
Benzodiazepine (BDZ) 1 0 2 1
Opiate + BDZ 1 1 0 0
Opiate + muscle relaxant +/- atropine 6 6 11 9
BDZ + muscle relaxant +/- atropine 1 0 0 0

Seven different combinations of premedication drugs were in routine use in Australia compared to 14 different combinations in the UK.

In Australian units, the routine administration of premedication for non-emergency tracheal intubation of term and pre-term neonates is common practice and there is some uniformity in the combinations of drugs used. In contrast this practice is less common in the UK 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.

1 Bhutada A, Sahani R, Rastogi S, Wung J-T. Randomised controlled trial of thiopental for intubation in neonates. Arch Dis Child Fetal Neonatal Ed 2000;82:F34-F37.

2 Whyte S, Birrell G, Wyllie J. Premedication before intubation in UK neonatal units. Arch Dis Child Fetal Neonatal Ed 2000;82:F38-F41.

Conflict of Interest

None declared