Ellen de Kort

73 Sedation assessment for neonatal intubation 5 INTRODUCTION A significant proportion of preterm and critically ill newborn infants needs endotracheal intubation at some point during their admission to the Neonatal Intensive Care Unit (NICU) or because of anesthesia. Indications range from respiratory insufficiency in case of pulmonary morbidity, sepsis, or necrotizing enterocolitis, and the administration of surfactant, to surgical procedures such as bowel surgery, surgical closure of a patent ductus arteriosus, laser coagulopathy in case of retinopathy of prematurity, or placement of a surgical central venous catheter. Endotracheal intubation is a painful and stressful procedure and often is associated with adverse physiological responses such as bradycardia, hypoxemia, systemic hypertension, and intracranial hypertension. 1-7 The use of premedication before intubation reduces the risk of these adverse events, and also reduces the duration and number of attempts needed for successful intubation and prevents traumatic injury to face, eyes, gums, tongue, and glottic structures. 6-11 Neonatal intubation should therefore be preceded by sedative premedication. The goal of administering premedication is to achieve a proper level of sedation before intubation is started or muscle relaxants are administered. Still the question is how this level of sedation should be defined and how this should be measured in the clinical situation. OBJECTIVES Our primary objective was to provide a systematic review of studies assessing the usability and validity of objective scoring systems or parameters to evaluate the level of sedation before intubation in newborn infants. Because we presumed that very few studies have addressed this issue, our secondary objective was to describe common practice, addressing the following two questions: 1. On what parameter(s) and/or criteria is the decision to proceed with intubation after the administration of premedication based? 2. Which (objective) scores or other parameters are used to determine the level of sedation after administration of premedication?