Premedication with ketamine or propofol for less invasive surfactant administration (LISA): observational study in the delivery room

Brotelande, Camille; Milési, Christophe; Combes, Clémentine; Durand, Sabine; Badr, Maliha; Cambonie, Gilles

doi:10.1007/s00431-021-04103-1

Cited by 14 publications

(32 citation statements)

References 12 publications

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“…In total, 945 newborns were included, with study recruitments ranging from 24 to 500 infants (78 in the RCT). Three studies focused on extremely and very preterm infants [24, 25, 28], one on moderate and late preterm [27], while the 4 others included preterm infants of all GAs.…”

Section: Resultsmentioning

confidence: 99%

“…In the RCT by Dekker et al [20] and in cohort studies by Dekker et al [23] and Brotelande et al [25], groups were matched in terms of GA, birth weight, and sex. Krajewski et al [22] reported statistically significant differences in terms of GA and birth weight ( p < 0.001) with older and bigger infants in the analgosedation group.…”

Section: Resultsmentioning

confidence: 99%

“…Need for MV within 24 h was not different between awake and sedated infants [22, 23]. Brotelande et al [25] reported rates of 16 and 19% for propofol and ketamine groups, respectively. The intubation rate within 72 h of life reached 21% after propofol [25], 18–41% in ketamine studies [21, 25, 28], and 29% after fentanyl analgosedation [27].…”

Section: Resultsmentioning

confidence: 99%

“…Brotelande et al [25] reported rates of 16 and 19% for propofol and ketamine groups, respectively. The intubation rate within 72 h of life reached 21% after propofol [25], 18–41% in ketamine studies [21, 25, 28], and 29% after fentanyl analgosedation [27]. Four studies without an unsedated arm described the second dose of surfactant requirements from 6.4 to 37.5%, irrespectively of the choice of drug used (ketamine [25, 28], propofol [24, 25], or fentanyl [27]).…”

Section: Resultsmentioning

confidence: 99%

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Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Tribolet¹,

Hennuy²,

Snyers³

et al. 2022

Neonatology

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Background: Surfactant therapy is the cornerstone of respiratory distress syndrome management. “Less-invasive surfactant administration (LISA)” is now recommended for spontaneously breathing preterm infants. Analgosedation remains controversial as 52% of European neonatologists do not use any. This systematic review aims to describe the efficacy and safety of different drugs for analgosedation during LISA. Methods: MEDLINE via Ovid, Embase, Scopus, and Cochrane Library of Trials were searched independently by 2 reviewers for studies on sedation or analgesia for LISA, without filters or limits. Results: Eight studies (1 randomized controlled trial) recruiting 945 infants were included. Infant pain was significantly reduced, with more infants evaluated as comfortable. Failure, defined as need for intubation or for a second dose of surfactant, was not different between sedated and unsedated groups. Analgosedation was associated with a higher occurrence of desaturation and need for positive pressure ventilation during procedure, but the need for mechanical ventilation within 24 or 72 h of life was not significantly different. There does not seem to be any difference in clinical tolerance and complications (e.g., hypotension, mortality, air leaks, etc.). Procedural conditions were evaluated as good or excellent in 83% after sedation. Discussion and Conclusion: Analgesia or sedative drugs increase infant comfort and allow good procedural conditions, with a limited impact on the clinical evolution. Questions remain about the best choice of drugs and dosages, with the constraint to maintain spontaneous breathing and have a rapid offset. Further good quality studies are needed to provide additional evidence to supplement those limited existing data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Tribolet¹,

Hennuy²,

Snyers³

et al. 2022

Neonatology

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“…On admission, 3 h after birth, the fraction of inspired oxygen (FiO2) required to maintain adequate oxygenation had increased to 70%, prompting surfactant administration (200 mg/kg of poractant alfa), according to the less invasive surfactant administration procedure with propofol (1 mg/kg) for premedication, as stated in our service protocol [ 15 ]. Soon after, the FiO 2 required to maintain adequate oxygenation decreased to 25% and capillary blood gases showed improved pH (7.28) and lactate (6.8 mmol/L) compared to cord blood values.…”

Section: Case Presentationmentioning

confidence: 99%

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

et al. 2021

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Background Tenfold or more overdose of a drug or preparation is a dreadful adverse event in neonatology, often due to an error in programming the infusion pump flow rate. Lipid overdose is exceptional in this context and has never been reported during the administration of a composite intravenous lipid emulsion (ILE). Case presentation Twenty-four hours after birth, a 30 weeks’ gestation infant with a birthweight of 930 g inadvertently received 28 ml of a composite ILE over 4 h. The ILE contained 50% medium-chain triglycerides and 50% soybean oil, corresponding to 6 g/kg of lipids (25 mg/kg/min). The patient developed acute respiratory distress with echocardiographic markers of pulmonary hypertension and was treated with inhaled nitric oxide and high-frequency oscillatory ventilation. Serum triglyceride level peaked at 51.4 g/L, 17 h after the lipid overload. Triple-volume exchange transfusion was performed twice, decreasing the triglyceride concentration to < 10 g/L. The infant’s condition remained critical, with persistent bleeding and shock despite supportive treatment and peritoneal dialysis. Death occurred 69 h after the overdose in a context of refractory lactic acidosis. Conclusions Massive ILE overdose is life-threatening in the early neonatal period, particularly in premature and hypotrophic infants. This case highlights the vigilance required when ILEs are administered separately from other parenteral intakes. Exchange transfusion should be considered at the first signs of clinical or biological worsening to avoid progression to multiple organ failure.

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Alternative routes of surfactant application – An update

Kribs,

Roberts,

Trevisanuto

et al. 2023

Seminars in Fetal and Neonatal Medicine

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Premedication with ketamine or propofol for less invasive surfactant administration (LISA): observational study in the delivery room

Cited by 14 publications

References 12 publications

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review

Fatal accidental lipid overdose with intravenous composite lipid emulsion in a premature newborn: a case report

Alternative routes of surfactant application – An update

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