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
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The effect of sedative drugs (analgesics, sedatives, anesthetics) compared to the effect of no-sedation for LISA in preterm infants with RDS is underexplored.
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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.
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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.
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Data availability
All data generated or analyzed during this study are included in this published article and its Supplementary information files.
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Acknowledgements
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.
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L.M., V.V.R., C.C.R., and S.H.P.S. gave substantial contributions to conception and design, acquisition of data, analysis, and interpretation of data of this manuscript. L.M., V.V.R., I.K.M.R., E.B., C.C.R., and S.H.P.S. drafted the article and revised it critically for important intellectual content. All the authors approved the final version of the manuscript to be published.
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Moschino, L., Ramaswamy, V.V., Reiss, I.K.M. et al. Sedation for less invasive surfactant administration in preterm infants: a systematic review and meta-analysis. Pediatr Res 93, 471–491 (2023). https://doi.org/10.1038/s41390-022-02121-9
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DOI: https://doi.org/10.1038/s41390-022-02121-9
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