Ellen de Kort

ABSTRACT Background: Premedication for neonatal intubation facilitates the procedure and reduces stress and physiological disturbances. However, no validated scoring system to assess the effect of premedication prior to intubation is available. Objective: To evaluate the usefulness of an Intubation Readiness Score (IRS) to assess the effect of premedication prior to intubation in newborn infants. Methods: Two-center prospective study in neonates who needed endotracheal intubation. Intubationwas performed using a standardized procedurewith propofol 1-2 mg/kg as premedication. The level of sedationwas assessedwith the IRS by evaluating the motor response to a firm stimulus (1 = spontaneous movement; 2 = movement on slight touch; 3 = movement on firm stimulus; 4 = no movement). Intubation was proceeded if an adequate effect, defined as an IRS 3 or 4, was reached. IRSwas related to the quality of intubation measured with the Viby-Mogensen intubation score. Results: A total of 115 patients, with amedian gestational age of 27.7weeks (interquartile range 5.3) and a median birthweight of 1,005 g (interquartile range 940), were included. An adequate IRSwas achieved in 105 patients, 89 (85%) of whom also had a goodViby- Mogensen intubation score and 16 (15%) had an inadequate Viby-Mogensen intubation score. The positive predictive value of the IRS was 85%. Conclusions: Pre-intubation sedation assessment using the IRS can adequately predict optimal conditions during intubation in the majority of neonates. We suggest using the IRS in routine clinical care. Additional research combining the IRS with other parameters could further improve the predictability of adequate sedation during intubation.