A systematic review and meta-analysis on the safety and efficacy of premedication prior to elective intubation in neonates

Objective: Endotracheal intubation, as an emergent but also as an elective procedure, can be stressful and painful, causing hypoxemia, bradycardia, acidosis or increased intracranial pressure. We aimed to investigate the safety and efficacy of premedication prior to elective intubation in order to c...

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Main Authors: Ilias Chatziioannidis (Author), Georgios N. Katsaras (Author), Abraham Pouliakis (Author), Zoi Arvanitaki (Author), Dimitra Gialamprinou (Author), Georgios Mitsiakos (Author)
Format: Book
Published: Hygeia Press di Corridori Marinella, 2024-08-01T00:00:00Z.
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042 |a dc 
100 1 0 |a Ilias Chatziioannidis  |e author 
700 1 0 |a Georgios N. Katsaras  |e author 
700 1 0 |a Abraham Pouliakis  |e author 
700 1 0 |a Zoi Arvanitaki  |e author 
700 1 0 |a Dimitra Gialamprinou  |e author 
700 1 0 |a Georgios Mitsiakos  |e author 
245 0 0 |a A systematic review and meta-analysis on the safety and efficacy of premedication prior to elective intubation in neonates 
260 |b Hygeia Press di Corridori Marinella,   |c 2024-08-01T00:00:00Z. 
500 |a 2281-0692 
500 |a 10.7363/130201 
520 |a Objective: Endotracheal intubation, as an emergent but also as an elective procedure, can be stressful and painful, causing hypoxemia, bradycardia, acidosis or increased intracranial pressure. We aimed to investigate the safety and efficacy of premedication prior to elective intubation in order to contribute to the development of a more standardized strategy. Method: A systematic review and meta-analysis was conducted. The PubMed database was searched using the PICO method and keywords according to MeSH terms were used. Only studies with control groups were included (ran­domized controlled trials, prospective observational and case-control studies). Results: Our search procedure yielded 722 potentially eligible studies. Finally, 26 studies were included for qualitative and quantitative analysis. Blood pressure during intubation was found lower for neonates that received premedication compared to controls (SMD = -1.27; 95% CI [-2.59; 0.05]; p < 0.01). Heart rate change was found higher in the control group (SMD = -0.26; 95% CI [-1.07; 0.55]; p = 0.54). Intervention groups were found to have higher odds for bradycardia (OR = 1.13; 95% CI [0.79; 1.62]; p = 0.51), and less odds for desaturation compared to control groups (OR = 0.69; 95% CI [0.33; 1.45]; p = 0.33). The odds for adverse events were found 3 times lower in the intervention group, in relation to controls (OR = 0.71; 95% CI [0.55; 0.73]; p = 0.012). Intubation time for the intervention groups was lower than controls (SMD = -0.59; 95% CI [-1.06; -0.11]; p < 0.02). Intubation attempts were found marginally increased in the intervention group (ROM = 1.10; 95% CI [0.79; 1.53]; p = 0.57). No difference was found regarding mortality rate between groups. Conclusion: Most Neonatal Intensive Care Units should consider premedication prior to intubation for vigorously and active term and preterm infants as a safe and efficient procedure that buffers serious physiological responses and assures better procedural conditions. 
546 |a EN 
546 |a IT 
690 |a intubation 
690 |a premedication 
690 |a neonates 
690 |a sedatives 
690 |a anesthesia 
690 |a pain 
690 |a Medicine 
690 |a R 
690 |a Pediatrics 
690 |a RJ1-570 
655 7 |a article  |2 local 
786 0 |n Journal of Pediatric and Neonatal Individualized Medicine, Vol 13, Iss 2, Pp e130201-e130201 (2024) 
787 0 |n https://jpnim.com/index.php/jpnim/article/view/1625 
787 0 |n https://doaj.org/toc/2281-0692 
856 4 1 |u https://doaj.org/article/5db0f1697f644ec1a1ab521a54e909b0  |z Connect to this object online.