Nebulized racemic epinephrine for extubation of newborn infants

The use of inhaled nebulized epinephrine after extubation in newborn infants is not supported or refuted by evidence from randomised controlled trials. Following mechanical ventilation, airway swelling and obstruction can occur in newborn infants (especially after prolonged, traumatic or multiple intubations). This may compromise breathing and cause failure of extubation. Because epinephrine can decrease swelling and its effect has been proven in the treatment of croup in infants, it has been used immediately after extubation to prevent breathing problems. The reviewers did not identify any studies that examined clinically relevant outcomes following the use of nebulized epinephrine in newborn infants. They concluded that there is no evidence either supporting or refuting the use of inhaled nebulized epinephrine in newborn infants.