Premedication with Fentanyl for Less Invasive Surfactant Application (LISA): A Randomized Controlled Trial

Area of Science:

• Neonatal Medicine
• Pediatric Anesthesiology
• Respiratory Care

Background:

• Less invasive surfactant administration (LISA) is a key procedure for preterm infants with respiratory distress syndrome (RDS).
• Optimal analgesic premedication for LISA remains debated, impacting infant comfort and procedural outcomes.

Purpose of the Study:

• To evaluate the efficacy of low-dose fentanyl as premedication for comfort during LISA in preterm infants.
• To compare the comfort levels and procedural complications between infants receiving fentanyl and those not receiving premedication.

Main Methods:

• A randomized controlled trial involving 34 preterm infants (28+0-33+6 weeks gestation) with RDS.
• Infants received either intravenous fentanyl (1 μg/kg) or no premedication before LISA.
• Comfort was assessed using the revised premature infant pain profile (R-PIPP) score (≤12 indicating comfort).

Main Results:

• A significantly higher proportion of infants in the fentanyl group achieved a comfort score (R-PIPP ≤12) compared to the no-premedication group (88.23% vs. 47.05%; p=0.025).
• No significant differences were observed in secondary outcomes, including procedural complications, hemodynamically significant patent ductus arteriosus (hsPDA), intraventricular hemorrhage (IVH), or bronchopulmonary dysplasia (BPD).

Conclusions:

• Low-dose fentanyl during LISA enhances preterm infant comfort without increasing procedural or drug-related complications.
• Further research is warranted to establish definitive, safe, and effective pharmacologic strategies for pain prevention during LISA.