Association of atropine use during neonatal intubation with cardiac arrest, severe bradycardia, and other adverse events: a report from NEAR4NEOS
In brief
Atropine linked to 67% lower odds of severe bradycardia, but not cardiac arrest
In a retrospective study of 13,085 neonatal intubations, atropine use was associated with lower odds of severe bradycardia, but not a clear reduction in cardiac arrest. It was also associated with more oxygen desaturation and lower first-attempt success. Because the study shows associations rather than cause and effect, whether atropine improves overall safety needs further study.
- Journal
- Journal of perinatology : official journal of the California Perinatal Association (Q1)
- Published
- 2 October 2026
- Study design
- Retrospective cohort
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Taylor Sawyer, Michael Narvey, Michelle D Tyler, Ayman Abou Mehrem, Sabine Iben, Cassandra DeMartino, et al.
- PMID
- 42827095
- DOI
- 10.1038/s41372-026-02916-2
Why clinicians should know about it
- Picked for Neonatology (paper of the day, 4 October 2026): Atropine during neonatal intubation reduces bradycardia
Abstract
OBJECTIVE: Evaluate the association between atropine use during neonatal tracheal intubation (TI) and procedural safety and success. STUDY DESIGN: Retrospective multicenter cohort study of neonatal TIs in the NEAR4NEOS registry (2014-2023). Multivariable logistic regression assessed associations between atropine use and cardiac arrest (primary outcome), along with safety and procedural outcomes, adjusting for confounders. RESULTS: Atropine was used in 8189 of 13,085 TIs (62.6%). It was not associated with reduced odds of cardiac arrest (aOR 0.52, 95% CI 0.25-1.09). Atropine use was associated with lower odds of severe bradycardia (aOR 0.33, 95% CI 0.26-0.41), but higher odds of oxygen desaturation (aOR 1.35, 95% CI 1.22-1.49) and lower first-attempt success (aOR 0.76, 95% CI 0.69-0.85). CONCLUSION: Atropine use during neonatal TI was not associated with reduced cardiac arrest. Although it reduced severe bradycardia, it was associated with increased desaturation and lower first-attempt success, warranting further study.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.