Nissimov Sagee, Kohn Amitai, Keidar Rimona, Livne Ayelet, Shemer Mazal, Gover Ayala, Hershkovich-Shporen Calanit, Berkovitch Matitiahu, Morag Iris
Department of Neonatology, Shamir Medical Center, Zerifin, Israel.
Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.
Paediatr Drugs. 2025 Mar;27(2):247-255. doi: 10.1007/s40272-024-00667-1. Epub 2024 Nov 22.
Less invasive surfactant administration (LISA) involves delivering surfactant to a spontaneously breathing infant by passing a thin catheter through the vocal cords and has become the preferred method for surfactant delivery. However, the role of pre-LISA sedation remains unclear.
The aim of this study was to describe the use of dexmedetomidine for LISA in preterm and early-term infants.
This retrospective study evaluated preterm and early-term infants who received intravenous dexmedetomidine for LISA between December 2022 and March 2024. Primary outcomes included safety parameters such as the absence of bradycardia, hypotension, hypothermia, or respiratory depression, and the success rate of LISA, determined by the lack of endotracheal intubation within 72 h. Intergroup comparison based on a cutoff of 32 weeks post-menstrual age (PMA) was performed.
Thirty-seven infants were included. The mean ± SD PMA at birth, birth weight, and age at LISA were 32.2 ± 2.7 weeks, 1879 ± 698 g, and 13.9 ± 12.4 h, respectively. Mean dexmedetomidine dosage was 0.66 ± 0.26 μg/kg. Six patients (16.2%) developed mild hypothermia, and 10 (27%) experienced apnea/bradycardia within 24 h. The success rate of the procedure was 89.2%. Infants born before 32 weeks received lower doses of dexmedetomidine than those born at 32 weeks and above (0.54 ± 0.24 versus 0.76 ± 0.24 μg/kg, p < 0.01). Safety and success rates of LISA were similar across groups.
This is the first report on dexmedetomidine as pre-LISA sedation, demonstrating its feasibility with comparable success rates regardless of PMA. These findings may inform future studies on sedation strategies for LISA.
微创表面活性剂给药（LISA）是通过一根细导管穿过声带将表面活性剂输送给自主呼吸的婴儿，已成为表面活性剂给药的首选方法。然而，LISA前镇静的作用仍不明确。
本研究的目的是描述右美托咪定在早产和早期足月婴儿LISA中的应用。
这项回顾性研究评估了2022年12月至2024年3月期间接受静脉注射右美托咪定进行LISA的早产和早期足月婴儿。主要结局包括安全参数，如无心动过缓、低血压、体温过低或呼吸抑制，以及LISA的成功率，通过72小时内未进行气管插管来确定。根据月经龄（PMA）32周的临界值进行组间比较。
纳入37例婴儿。出生时的平均±标准差PMA、出生体重和LISA时的年龄分别为32.2±2.7周、1879±698g和13.9±12.4小时。右美托咪定的平均剂量为0.66±0.26μg/kg。6例患者（16.2%）出现轻度体温过低，10例（27%）在24小时内出现呼吸暂停/心动过缓。该操作的成功率为89.2%。孕32周前出生的婴儿接受的右美托咪定剂量低于孕32周及以上出生的婴儿（0.54±0.24对0.76±0.24μg/kg，p<0.01）。LISA的安全性和成功率在各组之间相似。
这是关于右美托咪定作为LISA前镇静的首次报告，证明了其可行性，无论PMA如何，成功率相当。这些发现可能为未来关于LISA镇静策略的研究提供参考。
