Association of atropine use during neonatal intubation with cardiac arrest, severe bradycardia, and other adverse events: a report from NEAR4NEOS

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.