319 - A Prospective Study Of Ketamine Use In Neonatal Endotracheal Intubation

Publication Number: 4313.319

Monica Salama, Tallaght University Hospital, Dublin, Dublin, Ireland; Syed Iqtidar Hussain, Children’s Health Ireland at Crumlin Hospital, Dublin, Dublin, Ireland; Matthew McGovern, Coombe Women and Infants University Hospital, Dublin, Dublin, Ireland; John Kelleher, The Coombe hospital, Dublin, Dublin, Ireland

Background: Neonatal endotracheal intubation is a technically challenging procedure and may be associated with pain, hemodynamic instability, and transient respiratory compromise. Optimal premedication for intubation should be fast-acting, safe, and short-lived. Ketamine is an NMDA receptor antagonist with analgesic and amnesic properties and is used frequently as a premedication within our NICU. Ketamine has a favourable pharmacokinetic profile, yet evidence regarding its cardiorespiratory effects in neonates remains limited.

Objective: Our aim was to describe premedication practices within our NICU and assess the impact of ketamine on cardiovascular and respiratory parameters during neonatal intubation.

Design/Methods: A prospective cohort study was conducted at the Coombe Women and Infants University Hospital NICU from February to July 2025. Neonates undergoing endotracheal intubation or Less Invasive Surfactant Administration (LISA) within NICU were included. Primary outcomes were differences in heart rate and oxygen saturation during intubation between neonates who received ketamine as premedication and those who did not. Secondary outcomes included procedure duration, intubation quality, adverse events, and pain scores using the Revised Premature Infant Pain Profile (PIPP-R).

Results: Of the 26 intubation events analyzed, 54% received ketamine with concurrent atropine. Groups were comparable in baseline demographics. Intubation duration was longer in the ketamine group (mean 77 vs. 48 sec, p = 0.042). Ketamine administration was associated with higher mean and higher nadir heart rates (p = 0.002 and p = 0.007), and higher nadir oxygen saturation (p = 0.010). No significant differences were observed in pain scores, mean respiratory rate, or mean oxygen saturation.

Conclusion(s): Ketamine is an effective premedication for neonatal intubation and our data supports the theory that it allows maintenance of cardiovascular stability and oxygenation during neonatal intubation. These findings provide evidence for its use in NICU premedication protocols and highlight the need for larger studies to inform practice.