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PLoS One. 2019 Apr 10;14(4):e0215150. doi: 10.1371/journal.pone.0215150. eCollection 2019.

Premedication practices for delivery room intubations in premature infants in France: Results from the EPIPAGE 2 cohort study.

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Medicine and Neonatal Intensive Care Unit, Saint Joseph Hospital, Paris, France.
Paediatric Emergency Department. Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Paediatric and Neonatal Intensive Care Unit, University Hospital Arnaud de Villeneuve, Montpellier, France.
INSERM, U1153, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Obstetrical, Perinatal and Pediatric Epidemiology Team, Paris, France.
Paris Descartes University France, Paris, France.
URC - CIC P1419, Cochin Hotel-Dieu Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Division of Neonatology and CIC-1414, Department of Pediatrics, University Hospital, Rennes, France.
LTSI, Inserm U1099, Université de Rennes 1, Rennes, France.
Neonatal and Paediatric Intensive Care Unit, University hospital, Amiens, France.
PériTox - UMI 01, Medicine University, Picardie Jules Verne University, Amiens, France.
Paediatric and Neonatal Intensive Care Unit, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.
Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, University Paris Est Créteil, Créteil, France.



To assess premedication practices before tracheal intubation of premature newborns in the delivery room (DR).


From the national population-based prospective EPIPAGE 2 cohort in 2011, we extracted all live born preterms intubated in the DR in level-3 centers, without subsequent circulatory resuscitation. Studied outcomes included the rate and type of premedication, infants' and maternities' characteristics and survival and major neonatal morbidities at discharge from hospital. Univariate and multivariate analysis were performed and a generalized estimating equation was used to identify factors associated with premedication use.


Out of 1494 included neonates born in 65 maternities, 76 (5.1%) received a premedication. Midazolam was the most used drug accounting for 49% of the nine drugs regimens observed. Premedicated, as compared to non premedicated neonates, had a higher median [IQR] gestational age (30 [28-31] vs 28 [27-30] weeks, p<10-3), median birth weight (1391 [1037-1767] vs 1074 [840-1440] g, p<10-3) and median 1-minute Apgar score (8 [6-9] vs 6 [3-8], p<10-3). Using univariate analyses, premedication was significantly less frequent after maternal general anesthesia and during nighttime and survival without major morbidity was significantly higher among premedicated neonates (56/73 (81.4%) vs 870/1341 (69.3%), p = 0.028). Only 10 centers used premedication at least once and had characteristics comparable to the 55 other centers. In these 10 centers, premedication rates varied from 2% to 75%, and multivariate analysis identified gestational age and 1-minute Apgar score as independent factors associated with premedication use.


Premedication rate before tracheal intubation was only 5.1% in the DR of level-3 maternities for premature neonates below 34 weeks of gestation in France in 2011 and seemed to be mainly associated with centers' local policies.

Conflict of interest statement

The authors have declared that no competing interests exist.

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