Premedication before intubation in UK neonatal units

Aims-To establish the extent and type of premedication used before intubati on in neonatal units in the United Kingdom. Methods-A structured telephone survey was conducted of 241 eligible units. Units were subdivided into those that routinely intubated and ventilated ba bies (routine group) and those that transferred intubated and ventilated ba bies (transfer group). Results-Of the units contacted, 239 (99%) participated. Only 88/239 (37%) g ave any sedation before intubating on the unit and only 34/239 (14%) had a written policy covering this. Morphine was used most commonly (66%), with o ther opioids and benzodiazepines used less frequently. Of the 88 units usin g sedation, 19 (22%) also used paralysis. Suxamethonium was given by 10/19 (53%) but only half of these combined it with atropine. Drug doses varied b y factors of up to 200, even for commonly used drugs. Conclusion-Most UK neonatal units do not sedate babies before intubating, d espite evidence of physiological and practical benefits. Only a minority ha ve written guidelines, which prohibits auditing of practice.