Neonatal Intensive Care Unit, Department of Women's and Children's Health, Padova University Hospital, Padua, Italy.
Department of Neonatology, Ankura Hospital, Hyderabad, India.
Pediatr Res. 2023 Feb;93(3):471-491. doi: 10.1038/s41390-022-02121-9. Epub 2022 Jun 2.
Sedation to preterm neonates receiving less invasive surfactant administration (LISA) for respiratory distress syndrome is controversial.
Systematic review and meta-analysis of randomized controlled trials (RCTs) and observational studies (OS) to evaluate the effect of sedative drugs for LISA on respiratory outcomes and adverse effects.
One RCT (78 neonates) and two OS (519 neonates) were analyzed in pairwise meta-analysis and 30 studies (2164 neonates) in proportion-based meta-analysis. Sedative drugs might not affect the duration of the procedure [RCT: mean difference (MD) (95% CI); -11 (-90; 67) s; OS: MD 95% CI: -60 (-178; 58) s; low certainty of evidence (CoE)]. Evidence for success at the first attempt and rescue intubation was uncertain (very low CoE). The risk of nasal intermittent positive pressure ventilation [RCT: 1.97 (1.38-2.81); OS: RR, 95% CI: 2.96 (1.46; 6.00), low CoE], desaturation [RCT: RR, 95% CI: 1.30 (1.03; 1.65), low CoE], and apnea [OS: RR, 95% CI: 3.13 (1.35; 7.24), very low CoE] might be increased with sedation. Bradycardia, hypotension, and mechanical ventilation were comparable between groups (low CoE).
Use of sedative drugs for LISA temporarily affects the newborn's breathing. Further trials are warranted to explore the use of sedation for LISA.
The effect of sedative drugs (analgesics, sedatives, anesthetics) compared to the effect of no-sedation for LISA in preterm infants with RDS is underexplored. This systematic review and meta-analysis assesses the impact of sedative drugs compared to no-sedation for LISA on short-term pulmonary outcomes and potential adverse events. Sedative drugs for LISA temporarily affect the newborn's breathing (desaturation, apnea) and increase the need for nasal intermittent positive pressure ventilation. For most outcomes, certainty of evidence is low/very low.
对于接受经鼻持续气道正压通气（NCPAP）治疗呼吸窘迫综合征的早产儿，镇静的应用存在争议。
系统评价和荟萃分析随机对照试验（RCT）和观察性研究（OS），以评估镇静药物在 LISA 中的应用对呼吸结局和不良反应的影响。
在成对荟萃分析中，分析了一项 RCT（78 例新生儿）和两项 OS（519 例新生儿），在基于比例的荟萃分析中分析了 30 项研究（2164 例新生儿）。镇静药物可能不会影响操作的持续时间[RCT：平均差异（MD）（95%CI）；-11（-90；67）s；OS：MD 95%CI：-60（-178；58）s；低证据确定性（CoE）]。首次尝试和抢救插管成功的证据不确定（极低 CoE）。有创机械通气[RCT：1.97（1.38-2.81）；OS：RR，95%CI：2.96（1.46；6.00），低 CoE]、低氧血症[RCT：RR，95%CI：1.30（1.03；1.65），低 CoE]和呼吸暂停[OS：RR，95%CI：3.13（1.35；7.24），极低 CoE]的风险可能会增加。镇静组之间的心动过缓、低血压和机械通气无差异（低 CoE）。
LISA 中使用镇静药物会暂时影响新生儿的呼吸。需要进一步的试验来探索 LISA 中镇静的使用。
与 RDS 早产儿接受 LISA 时不镇静相比，镇静药物（镇痛药、镇静剂、麻醉剂）的作用尚未得到充分探索。本系统评价和荟萃分析评估了 LISA 中使用镇静药物与不镇静相比对短期肺结局和潜在不良事件的影响。LISA 中使用镇静药物会暂时影响新生儿的呼吸（低氧血症、呼吸暂停），并增加 NCPAP 的需求。对于大多数结局，证据确定性为低/极低。
