Variability of neonatal premedication practices for endotracheal intubation and LISA in the UK (NeoPRINT survey)

Abstract

Objective: The NeoPRINT Survey was designed to assess premedication practices throughout UK NHS Trusts for both neonatal endotracheal intubation and less invasive surfactant administration (LISA).

Design: An online survey consisting of multiple choice and open answer questions covering preferences of premedication for endotracheal intubation and LISA was distributed over a 67-day period. Responses were then analysed using STATA IC 16.0.

Setting: Online survey distributed to all UK Neonatal Units (NNUs).

Participants: The survey evaluated premedication practices for endotracheal intubation and LISA in neonates requiring these procedures.

Main outcome measures: The use of different premedication categories as well as individual medications within each category was analysed to create a picture of typical clinical practice across the UK.

Results: The response rate for the survey was 40.8 % (78/191). Premedication was used in all hospitals for endotracheal intubation but overall, 50 % (39/78) of the units that have responded, use premedications for LISA. Individual clinician preference had an impact on premedication practices within each NNU.

Conclusion: The wide variability on first-line premedication for endotracheal intubation noted in this survey could be overcome using best available evidence through consensus guidance driven by organisations such as British Association of Perinatal |Medicine (BAPM). Secondly, the divisive view around LISA premedication practices noted in this survey requires an answer through a randomised controlled trial.

Keywords: Intubation; LISA; Neonate; Premedication.