Sedation during Minimal Invasive Surfactant Therapy in Preterm Infants

Abstract

Background: There is no data available whether sedation should be given during minimally invasive surfactant therapy (MIST). Objective: To compare the level of comfort of preterm infants receiving sedation versus no sedation for MIST. Methods: A retrospective study of preterm infants receiving MIST was performed in Leiden University Medical Center in 2014. Sedation (propofol 1 mg/kg) was optional and left to the discretion of the caregiver. Standardized COMFORTneo scores were compared, and COMFORTneo <14 was considered comfortable. Basic characteristics and complications were noted. Results: In 38 infants receiving MIST, 23 received propofol and 15 were not sedated. Mean (SD) gestational age [29 (2) vs. 29 (3) weeks] and birth weight [1,312 (483) vs. 1,469 (588) g] were not different. Median (IQR) COMFORTneo was not different between the groups before [11 (9-15) vs. 10 (8-12)] and after MIST [10 (8-12) vs. 9 (8-10)], but lower in the sedated group during MIST [12 (9-17) vs. 20 (15-23)] with more often COMFORTneo <14 (56 vs. 11%). Duration of MIST [2 (2-4) vs. 3 (2-7) min] and occurrence of bradycardia (13 vs. 33%) and hypotension (21 vs. 18%) were not different. Although not significant, intubation occurred more often in the sedated group (during MIST: 9 vs. 0%, <24 h after MIST: 26 vs. 13%). During MIST, oxygen saturation <80% lasted longer in the sedated group [3 (2-4) vs. 1 (0-2) min], and nasal intermittent positive pressure ventilation was applied more (100 vs. 33%). Conclusions: Preterm infants receiving MIST were more comfortable when sedation was given, but needed ventilation more often. A randomized controlled trial is warranted to test whether the benefit of sedation outweighs the risks of complications.

Less invasive surfactant administration versus intubation for surfactant delivery in preterm infants with respiratory distress syndrome: a systematic review and meta-analysis

“…It is difficult to comment from the available data whether the use of premedication would help reduce the incidence of bradycardia and/or desaturation episodes during the LISA procedure, as noted in some studies 31 32. A recent cohort control study showed better comfort scores with the use of sedation but a greater risk of intubation during or within 24 hours after the procedure 40. Future studies could determine the benefits and the risks associated with the use of sedation during the LISA procedure.…”

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

“…Many clinicians prefer to use a combination of a short-acting opiate, muscle relaxant and atropine to maximize comfort and improve the chances of successful intubation [164]. However, there is a balance between ensuring comfort during laryngoscopy and not oversedating infants when trying to maintain them on non-invasive respiratory support [165]. Once stable on ventilation there is usually no need for routine sedation [166].…”

Propofol for sedation during less invasive surfactant administration in preterm infants

“…International guidelines recommend sedation for intubation but it can hamper spontaneous breathing, which is necessary for LISA. Recently, a study compared two groups undergoing LISA with or without sedation: the sedated newborns were more comfortable but needed ventilation more often 3. We report a retrospective analysis of 35 preterm infants who were sedated with propofol for LISA.…”