Review

. 2023 Jan 4:10:1075184.

doi: 10.3389/fped.2022.1075184. eCollection 2022.

Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN)

Xavier Durrmeyer^{1

2}, Elizabeth Walter-Nicolet^{3

4}, Clément Chollat⁵, Jean-Louis Chabernaud⁶, Juliette Barois⁷, Anne-Cécile Chary Tardy⁸, Daniel Berenguer⁹, Antoine Bedu¹⁰, Noura Zayat¹¹, Jean-Michel Roué¹², Anne Beissel¹³, Claire Bellanger¹⁴, Aurélie Desenfants¹⁵, Riadh Boukhris¹⁶, Anne Loose¹⁷, Clarisse Massudom Tagny¹⁸, Marie Chevallier^{19

20}, Christophe Milesi²¹, Manon Tauzin¹

Affiliations

¹ Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
² Université Paris Est Créteil, Faculté de Santé de Créteil, IMRB, GRC CARMAS, Créteil, France.
³ Neonatal Medicine and Intensive Care Unit, Saint Joseph Hospital, Paris, France.
⁴ University of Paris-Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France.
⁵ Department of Neonatology, Hôpital Armand Trousseau, APHP, Sorbonne Université, Paris, France.
⁶ Division of Neonatal and Pediatric Critical Care Transportation, Hôpital Antoine Beclere, AP-HP, Paris - Saclay University Hospital, Clamart, France.
⁷ Department of Neonatology and Neonatal Intensive Care, CH de Valenciennes, Valenciennes, France.
⁸ Department of Neonatology and Neonatal Intensive Care, Centre Hospitalier Universitaire de Dijon, Dijon, France.
⁹ Department of Pediatric Anesthesia and Pediatric Transport (SMUR Pédiatrique), Hôpital des Enfants, CHU de Bordeaux, Bordeaux, France.
¹⁰ Department of Neonatal Pediatrics and Intensive Care, Limoges University Hospital, Limoges, France.
¹¹ Department of Neonatal Intensive Care and Pediatric Transport, CHU de Nantes, Nantes, France.
¹² Department of Pediatric and Neonatal Critical Care, Brest University Hospital, Brest, France.
¹³ Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
¹⁴ Department of Neonatology and Neonatal Intensive Care, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
¹⁵ Department of Neonatology, CHU Nimes, Université Montpellier, Nimes, France.
¹⁶ Department of Neonatology, Pôle Femme-Mère-Nouveau-Né, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France.
¹⁷ Department of Neonatology, CHRU de Tours, Hôpital Bretonneau, Tours, France.
¹⁸ Department of Neonatology and Neonatal Intensive Care, Grand Hôpital de L'Est Francilien, Meaux, France.
¹⁹ Department of Neonatal Intensive Care Unit, CHU Grenoble, Grenoble, France.
²⁰ TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France.
²¹ Department of Neonatal Medicine and Pediatric Intensive Care, Montpellier University Hospital, Université de Montpellier, Montpellier, France.

PMID: 36683794
PMCID: PMC9846576
DOI: 10.3389/fped.2022.1075184

Review

Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN)

Xavier Durrmeyer et al. Front Pediatr. 2023.

. 2023 Jan 4:10:1075184.

doi: 10.3389/fped.2022.1075184. eCollection 2022.

Authors

Affiliations

¹ Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
² Université Paris Est Créteil, Faculté de Santé de Créteil, IMRB, GRC CARMAS, Créteil, France.
³ Neonatal Medicine and Intensive Care Unit, Saint Joseph Hospital, Paris, France.
⁴ University of Paris-Cité, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRAE, Paris, France.
⁵ Department of Neonatology, Hôpital Armand Trousseau, APHP, Sorbonne Université, Paris, France.
⁶ Division of Neonatal and Pediatric Critical Care Transportation, Hôpital Antoine Beclere, AP-HP, Paris - Saclay University Hospital, Clamart, France.
⁷ Department of Neonatology and Neonatal Intensive Care, CH de Valenciennes, Valenciennes, France.
⁸ Department of Neonatology and Neonatal Intensive Care, Centre Hospitalier Universitaire de Dijon, Dijon, France.
⁹ Department of Pediatric Anesthesia and Pediatric Transport (SMUR Pédiatrique), Hôpital des Enfants, CHU de Bordeaux, Bordeaux, France.
¹⁰ Department of Neonatal Pediatrics and Intensive Care, Limoges University Hospital, Limoges, France.
¹¹ Department of Neonatal Intensive Care and Pediatric Transport, CHU de Nantes, Nantes, France.
¹² Department of Pediatric and Neonatal Critical Care, Brest University Hospital, Brest, France.
¹³ Neonatal Intensive Care Unit, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
¹⁴ Department of Neonatology and Neonatal Intensive Care, AP-HP, Hôpital Necker-Enfants Malades, Paris, France.
¹⁵ Department of Neonatology, CHU Nimes, Université Montpellier, Nimes, France.
¹⁶ Department of Neonatology, Pôle Femme-Mère-Nouveau-Né, Hôpital Jeanne de Flandre, Centre Hospitalier Universitaire de Lille, Lille, France.
¹⁷ Department of Neonatology, CHRU de Tours, Hôpital Bretonneau, Tours, France.
¹⁸ Department of Neonatology and Neonatal Intensive Care, Grand Hôpital de L'Est Francilien, Meaux, France.
¹⁹ Department of Neonatal Intensive Care Unit, CHU Grenoble, Grenoble, France.
²⁰ TIMC-IMAG Research Department, Grenoble Alps University, Grenoble, France.
²¹ Department of Neonatal Medicine and Pediatric Intensive Care, Montpellier University Hospital, Université de Montpellier, Montpellier, France.

PMID: 36683794
PMCID: PMC9846576
DOI: 10.3389/fped.2022.1075184

Abstract

Context: Laryngoscopy is frequently required in neonatal intensive care. Awake laryngoscopy has deleterious effects but practice remains heterogeneous regarding premedication use. The goal of this statement was to provide evidence-based good practice guidance for clinicians regarding premedication before tracheal intubation, less invasive surfactant administration (LISA) and laryngeal mask insertion in neonates.

Methods: A group of experts brought together by the French Society of Neonatology (SFN) addressed 4 fields related to premedication before upper airway access in neonates: (1) tracheal intubation; (2) less invasive surfactant administration; (3) laryngeal mask insertion; (4) use of atropine for the 3 previous procedures. Evidence was gathered and assessed on predefined questions related to these fields. Consensual statements were issued using the GRADE methodology.

Results: Among the 15 formalized good practice statements, 2 were strong recommendations to do (Grade 1+) or not to do (Grade 1-), and 4 were discretionary recommendations to do (Grade 2+). For 9 good practice statements, the GRADE method could not be applied, resulting in an expert opinion. For tracheal intubation premedication was considered mandatory except for life-threatening situations (Grade 1+). Recommended premedications were a combination of opioid + muscle blocker (Grade 2+) or propofol in the absence of hemodynamic compromise or hypotension (Grade 2+) while the use of a sole opioid was discouraged (Grade 1-). Statements regarding other molecules before tracheal intubation were expert opinions. For LISA premedication was recommended (Grade 2+) with the use of propofol (Grade 2+). Statements regarding other molecules before LISA were expert opinions. For laryngeal mask insertion and atropine use, no specific data was found and expert opinions were provided.

Conclusion: This statement should help clinical decision regarding premedication before neonatal upper airway access and favor standardization of practices.

Keywords: analgeisa; anesthesia; atropine; intubation (intratracheal); laryngeal mask; less invasive surfactant administration (LISA); neonate; sedation.

© 2023 Durrmeyer, Walter-Nicolet, Chollat, Chabernaud, Barois, Chary Tardy, Berenguer, Bedu, Zayat, Roué, Beissel, Bellanger, Desenfants, Boukhris, Loose, Massudon Tagny, Chevallier, Milesi and Tauzin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Conditions of statement application based on available resources.

**Figure 2**
Decision chart for premedication before tracheal intubation in neonates.

See this image and copyright information in PMC

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Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN)

Affiliations

Premedication before laryngoscopy in neonates: Evidence-based statement from the French society of neonatology (SFN)

Authors

Affiliations

Abstract

Conflict of interest statement

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