Department of Neonatology, University Center for Mother and Newborn's Health, Warsaw, Poland.
Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.
J Matern Fetal Neonatal Med. 2022 Dec;35(24):4750-4754. doi: 10.1080/14767058.2020.1863365. Epub 2020 Dec 25.
There are no established premedication schemes for less invasive surfactant administration (LISA) in neonatal RDS. The aim was to describe "real-world" practices and to assess the safety of premedication and its impact on the technical ease of the LISA procedure.
Data from the prospective LISA cohort study conducted in 31 tertiary neonatal units were evaluated for premedication practices. Infants who received analgesics and/or sedatives before LISA and those receiving non-pharmacological sedation with sublingual 30% glucose were compared versus nonpremedicated neonates, acting as a reference. Safety of premedication was assessed with the rate of adverse events during LISA, changes in oxygenation status, the need for rescue intubation, and mechanical ventilation in the first 24 h of life. Ease of conducting LISA was an efficacy endpoint.
Of 500 enrolled newborns, 102 (20.4%) received premedication for LISA; 88 infants were given analgesics/sedatives and 14 sublingual glucose. Pharmacological sedation was most often performed with ketamine (51/88; 57.9%), midazolam (16/88; 18.2%) and propofol (8/88; 1.6%). Compared to non-premedication, the use of analgesics/sedatives was associated with a significant increase in the rate of apnea (9.1 vs 2.6%; = 0.009) and a significantly higher decrease in SpO/FiO (-55 ± 62 vs -32 ± 50; < 0.001). However, the rates of rescue intubation and the need for early mechanical ventilation were not significantly different. Sedation with glucose did not affect the frequency of adverse events. LISA procedures had a similar level of ease regardless of the premedication used and were rated as or in 69% of non-premedicated infants, 65.9% of the analgesics/sedatives group and 78.5% of the glucose group (p = ns).
Analgesics/sedatives prior to LISA increased the rate of apnea and decreased blood oxygenation but did not lead to tracheal intubation and early mechanical ventilation. Trials addressing the impact on LISA-related stress are necessary to determine the ultimate usefulness of premedication.
对于新生儿呼吸窘迫综合征（RDS）的微创表面活性剂给药（LISA），目前尚无既定的预处理方案。本研究旨在描述“真实世界”中的实践情况，并评估预处理的安全性及其对 LISA 操作技术的影响。
对在 31 个三级新生儿单位进行的前瞻性 LISA 队列研究的数据进行预处理实践评估。将接受 LISA 前接受镇痛剂和/或镇静剂的婴儿与接受舌下 30%葡萄糖非药物镇静的婴儿以及未接受预处理的新生儿进行比较，后者作为参考。通过 LISA 期间不良事件的发生率、氧合状态的变化、需要抢救性气管插管以及生命最初 24 小时内的机械通气来评估预处理的安全性。LISA 操作的容易程度是一个疗效终点。
在 500 名入组的新生儿中，有 102 名（20.4%）接受了 LISA 的预处理；88 名婴儿接受了镇痛/镇静剂，14 名接受了舌下葡萄糖。最常使用的药物包括氯胺酮（51/88；57.9%）、咪达唑仑（16/88；18.2%）和丙泊酚（8/88；1.6%）。与未预处理相比，使用镇痛/镇静剂会显著增加呼吸暂停的发生率（9.1%比 2.6%；=0.009），SpO/FiO 显著降低（-55±62 比-32±50；<0.001）。然而，抢救性气管插管和早期机械通气的需要率没有显著差异。葡萄糖镇静不影响不良事件的发生频率。无论使用何种预处理，LISA 操作的难易程度相似，未预处理的新生儿中 69%、镇痛/镇静剂组中 65.9%和葡萄糖组中 78.5%的操作被评为或。（p=ns）
LISA 前使用镇痛/镇静剂会增加呼吸暂停的发生率并降低血氧，但不会导致气管插管和早期机械通气。需要进行试验来确定预处理对 LISA 相关应激的影响，以确定预处理的最终有用性。
