Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis

Laura Moschino, Viraraghavan Vadakkencherry Ramaswamy, Irwin Karl Marcel Reiss, Eugenio Baraldi, Charles Christoph Roehr*, Sinno Henricus Paulus Simons

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

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Abstract

Background: Sedation to preterm neonates receiving less invasive surfactant administration (LISA) for respiratory distress syndrome is controversial. Methods: 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. Results: 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). Conclusions: Use of sedative drugs for LISA temporarily affects the newborn’s breathing. Further trials are warranted to explore the use of sedation for LISA. Impact: 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.

Original languageEnglish
Pages (from-to)471-491
Number of pages21
JournalPediatric Research
Volume93
Issue number3
Early online date2 Jun 2022
DOIs
Publication statusPublished - Feb 2023

Bibliographical note

Funding Information:
This paper was written as part of the European Society for Pediatric Research (ESPR) Young Investigators Mentoring Program 2019. No financial assistance was received in support of this manuscript, although the ESPR financially supported L.M. and S.H.P.S. for the YIMP Meeting at the Joint of European Neonatal Societies (JENS) 2019. The authors would like to thank Sven Wellman and Heike Rabe for the initiative of this program and the ESPR for their support. The authors wish to thank Wichor Bramer from the Erasmus MC Medical Library for developing and updating the search strategies.

Funding Information:
This paper was written as part of the European Society for Pediatric Research (ESPR) Young Investigators Mentoring Program 2019. No financial assistance was received in support of this manuscript, although the ESPR financially supported L.M. and S.H.P.S. for the YIMP Meeting at the Joint of European Neonatal Societies (JENS) 2019. The authors would like to thank Sven Wellman and Heike Rabe for the initiative of this program and the ESPR for their support. The authors wish to thank Wichor Bramer from the Erasmus MC Medical Library for developing and updating the search strategies.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.

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