intubation; laryngoscopy; less invasive surfactant administration; neonates; premedication; Humans; Infant, Newborn; Prospective Studies; Female; Male; Belgium; Guideline Adherence/statistics & numerical data; Practice Guidelines as Topic; Intubation, Intratracheal; France; Laryngoscopy/methods; Premedication; Pediatrics, Perinatology and Child Health
Abstract :
[en] [en] OBJECTIVE: To evaluate the implementation of the 2023 French Society of Neonatology (SFN) guidelines for premedication before laryngoscopy in neonates without life-threatening emergencies.
STUDY DESIGN: A prospective, observational cohort study was conducted across 141 French and Belgian neonatal units. Laryngoscopy data from intubation or less invasive surfactant administration in neonates <45 weeks postmenstrual age were collected. The primary outcome was the proportion of premedication consistent with SFN guidelines. Factors associated with guideline compliance were analyzed using multivariable mixed-effects logistic regression adjusted for neonatal and procedural characteristics.
RESULTS: Six hundred seventy-three laryngoscopies were included. The mean (SD) gestational age was 30.1 (4.8) weeks. Of 506 intubations, 110 (21.7%) were immediate life-threatening emergencies. Among 396 non-life-threatening intubations, 357 (90.1%) were preceded by premedication with 169 (42.7%) consistent with SFN guidelines (propofol alone [n = 149, 37.6%]; a fast-acting opioid + muscle blocker [n = 20, 5.1%]). Independent factors associated with SFN guidelines compliance were non-emergent intubation (adjusted odds ratio 3.1 [95% CI 1.4-7.0]) and absence of hemodynamic compromise (adjusted odds ratio 31.0 [95% CI 6.4-150.3). Propofol and ketamine were the most frequent premedications before intubation, followed by opioids and/or anesthetics. Of the 167 less invasive surfactant administration procedures, 151 (90.4%) were preceded by a specific premedication including propofol (n = 84, 50.3%), consistent with SFN guidelines.
CONCLUSIONS: Ninety percent of non-life-threatening laryngoscopies were preceded by a premedication but fewer than half complied with SFN guidelines. Further studies on efficacy and tolerance of neonatal anesthetics and drugs associations are needed.
Disciplines :
Pediatrics Anesthesia & intensive care
Author, co-author :
Tauzin, Manon; Neonatal Intensive Care Unit, CHI Créteil, Créteil, France. Electronic address: manon.tauzin@chicreteil.fr
Tribolet, Sophie ; Université de Liège - ULiège > Département des sciences cliniques > Néonatologie
Goro, Seydou; Délégation de Recherche en Santé et à l'Innovation (DRSI), CHIC, Créteil, France
Durrmeyer, Xavier; Neonatal Intensive Care Unit, CHI Créteil, Créteil, France, Université Paris Est Créteil, Faculté de Santé, IMRB, GRC CARMAS, Créteil, France
Chevallier, Marie; Neonatal Intensive Care Unit, CHU Grenoble, Grenoble, France, TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France
Roué, Jean-Michel; Pediatric and Neonatal Critical Care, CHU Brest, Brest, France
Milesi, Christophe; Neonatal Medicine and Pediatric Intensive Care, CHU Montpellier, Montpellier, France
Chabernaud, Jean-Louis; Neonatal and Pediatric Critical Care Transportation, Hôpital Antoine Beclere, AP-HP, Paris - Saclay University Hospital, Clamart, France
Barois, Juliette; Neonatology and Neonatal Intensive Care, CH de Valenciennes, Valenciennes, France
Chary Tardy, Anne-Cécile; Neonatology and Neonatal Intensive Care, CHU de Dijon, Dijon, France
Bedu, Antoine; Neonatal Pediatrics and Intensive Care, CHU Limoges, Limoges, France
Zayat, Noura; Neonatal Intensive Care and Pediatric Transport, CHU de Nantes, Nantes, France
Beissel, Anne; Neonatal Intensive Care Unit, HFME, Hospices Civils de Lyon, Bron, France
Bellanger, Claire; Neonatology and Neonatal Intensive Care, AP-HP, Hôpital Necker-Enfants Malades, Paris, France
Desenfants, Aurélie; Neonatology, CHU Nimes, Université Montpellier, Nimes, France
Boukhris, Riadh; Neonatology, Hôpital Jeanne de Flandre, CHU de Lille, Lille, France
Loose, Anne; Neonatology, CHRU de Tours, Hôpital Bretonneau, Tours, France
Jung, Camille; Délégation de Recherche en Santé et à l'Innovation (DRSI), CHIC, Créteil, France, Université Paris Est Créteil, Faculté de Santé de Créteil, Créteil, France
Wang, Xavier; Délégation de Recherche en Santé et à l'Innovation (DRSI), CHIC, Créteil, France
Berenguer, Daniel; Pediatric Anesthesia and Pediatric Transport (SMUR Pédiatrique), CHU de Bordeaux, Bordeaux, France
Walter-Nicolet, Elizabeth; INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France, Neonatology Department, Pôle Femme-enfant, Centre Hospitalier des Quatre Villes, Saint Cloud, France
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