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Comment & Response
September 18, 2018

Premedication for Neonates Requiring Nonemergency Intubation—Reply

Author Affiliations
  • 1Neonatal Intensive Care Unit, Centre Hospitalier Intercommunal de Créteil, Creteil, France
  • 2Neonatal Intensive Care Unit, CHU Amiens, Amiens, France
  • 3Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris, France
JAMA. 2018;320(11):1199. doi:10.1001/jama.2018.10025

In Reply Drs Fideler and Grasshoff raise 2 concerns regarding our trial comparing 2 premedication regimens for neonates requiring nonemergency intubation in the neonatal intensive care unit (NICU).1 Concerning the potential neurotoxicity of anesthetics and analgesics on the developing human brain, epidemiological data on surgical anesthesia and experimental animal data2 have suggested an association between surgical anesthesia and neurodevelopmental impairment, resulting in an FDA warning in 2016. However, a single, brief exposure to a general anesthetic, as used in our study, was not within the scope of the FDA warning. Available data from premature infants exposed to anesthetics, sedatives, or analgesics in the NICU are limited but reassuring thus far.2 Epidemiological studies that found an association with neurodevelopmental impairment could not disentangle the respective roles of anesthetics, surgery, pain, or the underlying condition.2 Repeated early painful experiences in the NICU are associated with impaired neurodevelopment when premature infants are older,2 so it is necessary to evaluate the balance between eventual toxicity and pain. For this purpose, neurodevelopmental follow-up of the infants in the study is ongoing.