Premedication for Neonatal Intubation

Premedication for nonemergent neonatal intubations is beneficial in reducing adverse intubation-associated events, decreasing the number of intubation attempts, and decreasing the pain and discomfort associated with the procedure. Although the use of intubation premedication in the neonatal population is endorsed by both the American Academy of Pediatrics and the Canadian Paediatric Society, there is inconsistency and variability surrounding its use. This chapter reviews the classes of premedication including analgesics, sedatives, vagolytics, and paralytics, as well as their risks and benefits for neonatal intubations. It also reviews circumstances in which premedication for neonatal intubations should be more carefully considered, including for very low-birth weight infants, airway anomalies, and newer techniques for surfactant administration such as INSURE (INtubation-SURfactant-Extubation) method and LISA (less invasive surfactant administration).