J Pediatr. 2025 Jul 9:114719. doi: 10.1016/j.jpeds.2025.114719. Online ahead of print.
ABSTRACT
OBJECTIVE: To compare the rates of severe bradycardia (<80/min for >10 seconds) between neonates who received atropine-fentanyl-succinylcholine (atropine/standard of care group) vs placebo-fentanyl-succinylcholine (placebo/intervention group) before orotracheal intubation.
STUDY DESIGN: A multicenter, double-blind, randomized clinical trial of neonates receiving non-emergent intubation. Randomization was by computer generated tables with random block size, stratified by PMA at randomization (<34 weeks and ≥ 34 weeks). Primary outcome was severe bradycardia during the whole procedure (from administration of the study medication until completion of last successful intubation). Secondary outcomes included any bradycardia (<100/min for>10 seconds), number and duration of intubation attempts and hypoxemia (<80% for >10 seconds). Safety outcomes included profound bradycardia (<60/min for >10 seconds) and receipt of chest compression or epinephrine. Analysis was by intention-to-treat.
RESULTS: Seventy-three intubation events (60 infants) were randomized to administration of atropine (n=24) or placebo (n=49). Multiple attempts occurred in 33% of the events. No safety events occurred in either group. Severe bradycardia during the whole procedure was significantly higher in the placebo compared with the atropine group; RR 6.3 (95% CI 1.2 – 34.1). The placebo group had significantly higher rates and duration of overall bradycardia, but lower rates and duration of hypoxemia compared with the atropine group, probably related to the lower proportion of multiple attempts (27% vs 46%, p 0.09) and longer time to successful intubation (394 vs 283 seconds, p 0.08).
CONCLUSIONS: Among neonates receiving premedication for non-emergent intubation, atropine significantly reduced the rates and duration of severe and overall bradycardia compared with placebo.
PMID:40645282 | DOI:10.1016/j.jpeds.2025.114719
