Premedication for Less Invasive Surfactant Administration

About This Study

Early respiratory management of preterm infants immediately after birth should be as gentle as possible. With this so-called developmental approach, unnecessary invasive methods can be avoided or at least postponed. This kind of "soft landing" allows cardiorespiratory transition with fewer adverse outcomes. Less invasive surfactant administration (LISA) is a technique that involves delivery of surfactant to a spontaneously breathing infant through a thin catheter. This technique minimizes the risk for neonatal lung injury caused by positive pressure ventilation. LISA is nowadays widely used in neonatal intensive care units (NICU). Although less invasive, newborns exposed to this procedure need premedication prior the procedure. There is no consensus, which drug would be the optimal premedication for LISA and the research on this topic is lacking. An ideal premedication would treat the procedural pain without suppressing the infant's own breathing. The sedation and analgesia should start fast but the effect should be short-acting with as few adverse effects as possible. The aim of this randomized, controlled trial (RCT) is to evaluate the feasibility, efficacy and safety of LISA protocol with the premedication of either ketamine or fentanyl by investigating whether one or the other is associated with lower rate of adverse events, hence would be preferred choice for premedication protocol.

Conditions Studied

Interventions

• •Ketamine
• •Fentanyl

Eligibility

Inclusion Criteria:

* Gestational age at birth ≥26 weeks
* Respiratory insufficiency managed with non-invasive respiratory support (nasal continuous positive airway pressure or high-flow)
* Requirement for oxygen to maintain oxygen saturation in the target range and need for surfactant treatment (according to clinician's assessment)
* If further doses of surfactant are needed, patient can be re-randomized

Exclusion Criteria:

* Severe RDS with high oxygen requirements, severe respiratory acidosis and/or widespread atelectasis radiologically, such that ongoing ventilator support will be necessary after surfactant therapy (intubation in preferable to LISA if FiO2 \>40% at GA \<28 weeks and \>60% at GA ≥28 weeks)
* Maxillo-facial, tracheal or known pulmonary malformations
* Any known chromosomal abnormality or severe malformation
* An alternative cause for respiratory distress (e.g. congenital pneumonia or pulmonary hypoplasia)

Study Locations (1)