A Prospective, Multicenter, Observational StUdy of PREMEdication Before Laryngoscopy in NEOnates (SUPREMEneo).

Abstract

To evaluate the implementation of the 2023 French Society of Neonatology (SFN) guidelines for premedication before laryngoscopy in neonates without life-threatening emergencies. A prospective, observational cohort study was conducted across 141 French and Belgian neonatal units. Laryngoscopy data from intubation or less invasive surfactant administration in neonates <45 weeks postmenstrual age were collected. The primary outcome was the proportion of premedication consistent with SFN guidelines. Factors associated with guideline compliance were analyzed using multivariable mixed-effects logistic regression adjusted for neonatal and procedural characteristics. Six hundred seventy-three laryngoscopies were included. The mean (SD) gestational age was 30.1 (4.8) weeks. Of 506 intubations, 110 (21.7%) were immediate life-threatening emergencies. Among 396 non-life-threatening intubations, 357 (90.1%) were preceded by premedication with 169 (42.7%) consistent with SFN guidelines (propofol alone [n = 149, 37.6%]; a fast-acting opioid + muscle blocker [n = 20, 5.1%]). Independent factors associated with SFN guidelines compliance were non-emergent intubation (adjusted odds ratio 3.1 [95% CI 1.4-7.0]) and absence of hemodynamic compromise (adjusted odds ratio 31.0 [95% CI 6.4-150.3). Propofol and ketamine were the most frequent premedications before intubation, followed by opioids and/or anesthetics. Of the 167 less invasive surfactant administration procedures, 151 (90.4%) were preceded by a specific premedication including propofol (n = 84, 50.3%), consistent with SFN guidelines. Ninety percent of non-life-threatening laryngoscopies were preceded by a premedication but fewer than half complied with SFN guidelines. Further studies on efficacy and tolerance of neonatal anesthetics and drugs associations are needed.