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Premedication with ketamine or propofol for less invasive surfactant administration (LISA): observational study in the delivery room

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Abstract

Less invasive surfactant administration (LISA) has become increasingly popular in neonatal intensive care units (NICUs), but there are currently no guidelines for the premedication prior to this procedure. The aim of this observational study was to compare the efficacy and tolerance of intravenous administrations of ketamine and propofol before LISA in neonates born before 30 weeks of gestational age (GA). The primary outcome was requirement of intubation within 2 h of the procedure. One hundred and fourteen infants, with respective GA and birthweight of 27.6 (26.4, 28.7) weeks and 940 (805, 1140) g, were prospectively included from January 2016 to December 2019. Drug doses were 1 (0.5, 1) mg/kg for ketamine and 1 (1, 1.9) mg/kg for propofol, providing comparable comfort during LISA (p = 0.61). Rates of intubation within 2 h were 5/52 after ketamine, and 5/62 after propofol [aOR 0.54 (0.11–2.68)]. No difference was observed for rates of intubation at 24 h and 72 h following LISA, mortality, or severe morbidity.

Conclusion: Pending results from prospective trials, these findings suggest that ketamine or propofol can be used for premedication before LISA, as they show comparable efficacy and tolerance.

Trial registration: This study was recorded on the National Library of Medicine registry (https:// clinicaltrials.gov/ Identifier: NCT03705468).

What is Known?

• Less invasive surfactant administration (LISA) is increasingly used in spontaneously breathing premature infants supported with continuous positive airway pressure, but few data are available to guide adequate premedication for this procedure.

What is New?

• This observational study of 114 neonates, all less than 30-week gestational age and requiring surfactant without endotracheal tube in the delivery room, suggested that ketamine or propofol can be used for premedication before LISA with comparable efficacy and tolerance.

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Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

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Abbreviations

BPD:

Bronchopulmonary dysplasia

CPAP:

Continuous positive airway pressure

FANS:

Faceless Acute Neonatal Pain Scale

FiO2 :

Fraction of inspired oxygen

GA:

Gestational age

HR:

Heart rate

IMV:

Invasive mechanical ventilation

INSURE:

Intubation and surfactant administration followed by immediate extubation

LISA:

Less invasive surfactant administration

MABP:

Mean arterial blood pressure

NIV:

Noninvasive ventilation

SpO2 :

Pulse oximetry

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Authors and Affiliations

  1. Department of Neonatal Medicine and Pediatric Intensive Care, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France

    Camille Brotelande, Christophe Milési, Clémentine Combes, Sabine Durand, Maliha Badr & Gilles Cambonie

Authors
  1. Camille Brotelande
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  2. Christophe Milési
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  3. Clémentine Combes
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  4. Sabine Durand
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  5. Maliha Badr
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  6. Gilles Cambonie
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Contributions

Camille Brotelande and Christophe Milési conceived and designed the study, contributed to the search for published work, acquired and interpreted data, drafted the report. Clémentine Combes performed the data analysis, contributed to data interpretation, critically revised the report. Sabine Durand and Maliha Badr contributed to the search for published work, critically revised the report, made substantial contributions to the final manuscript. Gilles Cambonie conceived and designed the study, contributed to the search for published work, interpreted data, finalized the report, corresponding author.

Corresponding author

Correspondence to Gilles Cambonie.

Ethics declarations

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval of this study was obtained from the institutional review board of Montpellier University Hospital (2018-IRB-MTP-09-09).

Consent to participate

In accordance with the French law relating to observational research (Decree n ° 2016-1537 of November 16, 2016), an information note was sent to the parents, informing them on the objectives of the research and inviting them to report to the main investigator (Dr. C Milési) if they were opposed to the participation of their infant.

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Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Daniele De Luca

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Brotelande, C., Milési, C., Combes, C. et al. Premedication with ketamine or propofol for less invasive surfactant administration (LISA): observational study in the delivery room. Eur J Pediatr 180, 3053–3058 (2021). https://doi.org/10.1007/s00431-021-04103-1

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  • DOI: https://doi.org/10.1007/s00431-021-04103-1

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