Dr Charles C Roehr

Charles Christoph Roehr (M.D., PhD.) is a neonatal intensivist and clinical researcher, currently Hon. Senior Clinical Lecturer at the John Radcliffe Hospital, Oxford University Hospitals, NHS Foundation Trust . His special interest is neonatal stabilization/resuscitation and non-invasive respiratory support.

Charles studied Medicine in Berlin, Germany. He had his Paediatric training in the UK (Oxford) and at the Charité University Medical Centre in Berlin. Following the completion of his research and teaching degree at the Charité (Habilitation), Charles spent almost 2 years as post-doc researcher and clinician with Professors S. Hooper and P. Davis in Melbourne, Australia (2012-14) before he took up his position at Oxford.

Charles is an avid researcher and a strong proponent of evidence-based neonatology. He has published over 70 peer reviewed scientific articles and is one of the guideline authors of the European Resuscitation Council (ERC) guidelines on neonatal stabilization/ resuscitation.

On the European level, Charles is very active as officer of education, European Society of Neonatology (ESN) and council member and President-Elect of the European Society of Research (ESPR); he chairs the European Scientific Collaboration of Neonatal Resuscitation Research (ESCNR) and is the head of the European Respiratory Society’s neonatal and intensive care group (ERS Group 7.05).

I shall convince the audience that not all babies need sedation for intubation. My argument will be that contrary to common belief, using pharmacotherapy for intubating neonates in any instance may indeed not always be in the very best interest of our patients (Allegaert 2016). In fact, my honourable opponent’s claim that “Every baby should receive sedation for intubation” is a blunt generalization as it negates the patient’s perspective, which unquestionably will be circumstantial. The rigid claim for universal sedation might in fact remind the reader of the much cited “parachute experiment” where calls mandating the wearing of parachutes when jumping off planes were based on the assumption that those would be a prerequisite for preventing major trauma; however, as we now know, this paradigm has not ever been studied in any controlled setting and hence may be an overt generalization (Smith et al. 2003).

With regards to neonatal intubation, there have been until this day only a few randomised controlled trials (RCTs) investigating the efficacy, pharmacodynamics and hence safety drugs for intubation (Allegaert 2014). Nor is there enough published data to suggest that one agent, or in fact any combination of several pharmacological agents, provides safe and effective sedation and analgesia over another or in fact any other thoughtful combination. It is also noteworthy that few of the RCTs were actually ever designed or adequately powered to study mid- to long-term neurologic or systemic adverse drug reactions (ADR). Results from small scale RCTs have suggested significant ADRs. For instance Norman and co-workers have shown that premedication with morphine for neonatal intubation was associated with prolonged aeeG/ eeG depression, which was found independent of blood pressure changes (Norman 2013). Lastly, the circumstantial need for sedation (and analgesia) has not yet been fully explored nor have alternatives to pharmacological agents been much studied. To conclude, it often appears that the ubiquitous provision of pre-intubation pharmacotherapy might serve the doctor more than the patient. However, whilst it is invariably the patient who carries the consequences, it is always our first responsibility to “do no harm” (Smith C 2005).

2. Smith GSC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. BMJ. 2003; 327: 1459.

3. Allegaert K, van den Anker JN. Clinical pharmacology in neonates: small size, huge variability. Neonatology. 2014; 105: 344-9.

4. Norman E, Wikström S, Rosén I, Fellman V, Hellström-Westas L. Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants. Pediatr Res. 2013; 73: 87-94.

5. Smith CM. Origin and uses of primum non nocere–above all, do no harm! J Clin Pharmacol. 2005; 45: 371-7.