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Effect of premedication regimen on infant pain and stress response to endotracheal intubation

Journal of Perinatology volume 35, pages 415–418 (2015)Cite this article

Subjects

Abstract

Objective:

(1) Evaluate the effect of different medications on pain and stress in neonates during nonemergent endotracheal intubation; (2) determine whether gestational age affects medication use; (3) determine whether better sedation results in a decrease in the number of attempts and/or total time for the procedure.

Study design:

Prospective observational study. Infant responses were measured using a clinical pain scale and blood glucose, a biochemical marker of acute stress.

Result:

A total of 166 infants were included, with adjusted gestational ages 24 to 44 weeks at the time of procedure. Premedication regimens included no medication (‘none,’ 27%), morphine (19%), morphine+midazolam (11%), fentanyl (14%), fentanyl+midazolam (19%) and midazolam alone (10%). Fentanyl+midazolam resulted in lower pain scores and less increase in blood glucose (both P<0.0001). No other regimen was different from ‘none’. The most immature infants were less likely to receive premedication (P=0.023), although their pain scores and blood glucose responses were similar to more mature infants. None of the medication regimens reduced the total procedure time (P=0.55) or the number of attempts (P=0.145).

Conclusion:

Only fentanyl+midazolam significantly attenuated both the clinical pain score and the increase in blood glucose. Less mature infants had responses similar to those of more mature infants, but were less likely to receive premedication. None of the regimens decreased the time or number of attempts required for successful intubation.

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Acknowledgements

No financial support was received for this study, and the authors have no financial conflict of interest to disclose. There were no study sponsors involved in the study design, collection, analysis, and interpretation of data; the writing of the report; and the decision to submit the paper for publication. Curtis Caldwell wrote the first draft of the manuscript. There were no grants or other form of payment given to anyone to produce this manuscript.

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Authors and Affiliations

  1. Department of Pediatrics, University of New Mexico Health Sciences Center,

    C D Caldwell & K L Watterberg

  2. The University of New Mexico, Albuquerque, NM, USA

    C D Caldwell & K L Watterberg

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  1. C D Caldwell
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Correspondence to C D Caldwell.

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Caldwell, C., Watterberg, K. Effect of premedication regimen on infant pain and stress response to endotracheal intubation. J Perinatol 35, 415–418 (2015). https://doi.org/10.1038/jp.2014.227

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