ABSTRACT
Despite strong evidence of the benefits of rapid sequence intubation in neonates, it is still infrequently utilized in neonatal intensive care units [NICU], contributing to avoidable pain and secondary procedure-related physiological disturbances. The primary objective of this cross-sectional survey was to assess the practice of premedication and regimens commonly used before elective endotracheal intubation in NICUs in Saudi Arabia. The secondary aim was to explore neonatal physicians' attitudes regarding this intervention in institutions across Saudi Arabia. A web-based, structured questionnaire was distributed by the Department of Pediatrics, Umm Al Qura University, Mecca, to neonatal physicians and consultants of 10 NICUs across the country by E-mail. Responses were tabulated and descriptive statistics were conducted on the variables extracted. 85% responded to the survey. Although 70% believed it was essential to routinely use premedication for all elective intubations, only 41% implemented this strategy. 60% cited fear of potential side effects for avoiding premedication and 40% indicated that the procedure could be executed more rapidly without drug therapy. Treatment regimens varied widely among respondents. Rates of premedication use prior to non-emergent neonatal intubation are suboptimal. Flawed information and lack of unified unit policies hampered effective implementation. Evidence-based guidelines may influence country-wide adoption of this practice
ABSTRACT
Mechanical ventilation improves survival of preterm infants with respiratory failure. The aim of this study was to determine the success rate and short-term neonatal morbidities of early extubation in extremely low birth weight [ELBW] infants in a tertiary care neonatal intensive care unit [NICU]. Retrospective cohort study of ELBW infants admitted to a tertiary, neonatal intensive care referral unit from January 1st to December 31[st], 2005. The primary outcome was the success rate of early extubation in ELBW infants who were intubated at delivery, extubated in the first 48 hours of life, and did not require reintubation within 72 hours following extubation. Thirty of the 95 eligible infants were extubated early; of these 30 infants, 24 [80%] had a successful extubation. Infants extubated early had a higher mean birth weight [855 vs 745 g; P<.0001] and gestational age [27.3 vs 25.6 weeks; P<.0001]. ELBW infants who were extubated early had lower rates of death [relative risk [RR], 0.05; 95% Cl, [0.0, 0.79]; P=.003], intraventricular hemorrhage [IVH] [RR, 0.23; 95% Cl, 0.08, 0.70; P=.008], and patent ductus arteriosus [PDA] [RR, 0.76; 95% Cl, 0.60, 0.98; P=.03] compared with those who remained ventilated beyond the first 48 hours of life. The rate of successful early extubation in our unit exceeded the sole previously reported rate. Successful early extubation was associated with lower rates of death, IVH, and PDA in ELBW infants