Sedation during minimal invasive surfactant therapy: a randomised controlled trial

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Respiratory Support

Background:

• Minimal invasive surfactant therapy (MIST) is a less invasive alternative to intubation for preterm infants.
• The use of sedation during MIST is not standardized, with varying practices regarding its necessity and impact on infant stress.
• Understanding the effects of sedation is crucial for optimizing MIST protocols and infant outcomes.

Purpose of the Study:

• To compare the level of stress and comfort in preterm infants undergoing MIST with and without low-dose sedation.
• To evaluate the impact of low-dose propofol sedation on infant comfort during MIST.
• To assess secondary outcomes, including complications associated with MIST and sedation.

Main Methods:

• A randomized controlled trial involving preterm infants (26-36 weeks gestational age) undergoing MIST.
• Infants were randomized to receive either low-dose intravenous propofol (1 mg/kg) or no premedication.
• Standard comfort measures (sucrose, containment) were provided to both groups. COMFORTneo scores were used to assess comfort.

Main Results:

• Significantly more sedated infants achieved a COMFORTneo score <14, indicating greater comfort (76% vs. 22%, p<0.001).
• The incidence of desaturation (SpO2 <85%) was higher in the sedated group (91% vs. 69%, p=0.023).
• Sedated infants required more frequent transient nasal intermittent mandatory ventilation (93% vs. 47%, p<0.001). No differences in hypotension, bradycardia, intubation, or pneumothorax.

Conclusions:

• Low-dose sedation enhances comfort for preterm infants during MIST.
• The benefit of increased comfort must be weighed against the increased need for transient non-invasive respiratory support.
• Further research may explore optimal sedation strategies to balance comfort and respiratory stability during MIST.