Objective Despite strong evidence of the benefits of rapid sequence intubation in neonates, it is still infrequently utilized in neonatal intensive care units (NICU), contributing to avoidable pain and secondary procedure-related physiological disturbances.

Aim of the study was to assess the practice of premedication, regimens commonly used before elective endotracheal intubation and neonatologists attitudes regarding this intervention in institutions across Saudi Arabia and to develop evidence based recommendations.

Methods A web based, structured questionnaire was constructed to assess the use of premedication for elective endotracheal intubation and determine barriers to the procedure. The questionnaire was distributed via e-mail to neonatal specialists and consultants of 10 NICUs.

Results 68 (85%) of the clinicians responded to the survey. Most respondents were NICU consultants. Although 48 of the 68 responding physicians (70%) believed it was essential to routinely use premedication for all elective intubations, only 28 (41%) implemented this strategy. Fear of potential side effects was the most frequently cited reason for avoiding premedication. Treatment regimens varied widely among respondents.

Conclusion Rates of premedication prior to non-emergent intubation in neonates are suboptimal. Flawed information and lack of unified unit policy hampered effective implementation. Development of evidence based guideline may support country-wide adoption of this practice.