title: Sedation during Minimal Invasive Surfactant Therapy in Preterm Infants.
abstract: There is no data available whether sedation should be given during minimally invasive surfactant therapy (MIST).
  
  
  
  To compare the level of comfort of preterm infants receiving sedation versus no sedation for MIST.
  
  
  
  A retrospective study of preterm infants receiving MIST was performed in Leiden University Medical Center in 2014. Sedation (propofol 1 mg/kg) was optional and left to the discretion of the caregiver. Standardized COMFORTneo scores were compared, and COMFORTneo <14 was considered comfortable. Basic characteristics and complications were noted.
  
  
  
  In 38 infants receiving MIST, 23 received propofol and 15 were not sedated. Mean (SD) gestational age [29 (2) vs. 29 (3) weeks] and birth weight [1,312 (483) vs. 1,469 (588) g] were not different. Median (IQR) COMFORTneo was not different between the groups before [11 (9-15) vs. 10 (8-12)] and after MIST [10 (8-12) vs. 9 (8-10)], but lower in the sedated group during MIST [12 (9-17) vs. 20 (15-23)] with more often COMFORTneo <14 (56 vs. 11%). Duration of MIST [2 (2-4) vs. 3 (2-7) min] and occurrence of bradycardia (13 vs. 33%) and hypotension (21 vs. 18%) were not different. Although not significant, intubation occurred more often in the sedated group (during MIST: 9 vs. 0%, <24 h after MIST: 26 vs. 13%). During MIST, oxygen saturation <80% lasted longer in the sedated group [3 (2-4) vs. 1 (0-2) min], and nasal intermittent positive pressure ventilation was applied more (100 vs. 33%).
  
  
  
  Preterm infants receiving MIST were more comfortable when sedation was given, but needed ventilation more often. A randomized controlled trial is warranted to test whether the benefit of sedation outweighs the risks of complications.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Janneke
authors.initials: J
authors.lastname: Dekker
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.forename: Monique
authors.initials: M
authors.lastname: Rijken
authors.forename: Esther
authors.initials: E
authors.lastname: Rijntjes-Jacobs
authors.forename: Vivianne
authors.initials: V
authors.lastname: Smits-Wintjens
authors.forename: Arjan
authors.initials: A
authors.lastname: Te Pas
mesh_terms: D001724:Birth Weight; D001919:Bradycardia / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007022:Hypotension / Q000209:etiology; D007231:Infant, Newborn; D007234:Infant, Premature; D007385:Intermittent Positive-Pressure Ventilation; D008297:Male; D009426:Netherlands; D015742:Propofol / Q000008:administration & dosage*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives; D011663:Pulmonary Surfactants; D015742:Propofol