Dexmedetomidine for Lisa Procedure: a Single Center Experience

Background Respiratory Distress Syndrome (RDS) is the most common respiratory problem of preterm newborns. The preferred way to manage RDS is with Less Invasive Surfactant Administration (LISA), which involves direct laryngoscopy in spontaneously breathing infants. Despite its widespread diffusion, the optimal sedation protocol for LISA remains unclear. Dexmedetomidine, an α2-adrenergic agonist, offers sedative and analgesic properties with minimal respiratory depression. This pilot study evaluates the efficacy and safety of dexmedetomidine for analgesia and sedation during the LISA procedure. Methods This is a prospective observational study conducted in our tertiary Italian NICU from May 2021 to July 2024. We enrolled preterm neonates aged between 26 ⁺⁰ to 36 ⁺⁶ weeks, diagnosed with RDS who required LISA. Dexmedetomidine (1 mcg/kg) was administered intravenously before LISA. Primary outcomes included pain control assessed by Neonatal Infant Pain Scale (NIPS) score, sedation adequacy assessed by Neonatal Pain, Agitation, and Sedation Scale (N-PASS), and success rate of the procedure. We also assessed the safety of the procedure evaluating adverse events, such as intubation rates, apneas/desaturations, bradycardia, and hypotension. We divided the newborns into two groups based on a cut-off of 32 weeks. Results Forty seven preterm newborns received dexmedetomidine. The median (IQR) gestational age, birth weight (grams) and age (hours) at LISA were respectively 29+6 (28+5, 33+1), 1421 (1069-2074), 3(2.5-6). Pain scores indicated adequate pain control during the procedure (NIPS <4 in 76% during laryngoscopy). Mild sedation (N-PASS -2 to -5) was observed in 23% of patients before the procedure, lasting up to 60 minutes. Excessive sedation (N-PASS < -5) occurred in 7% of babies (3 patients). Laryngoscopy conditions were optimal in 90% of neonates (Goldberg score <6). Apnea/desaturation with/without bradycardia occurred in 13% of newborns. Six patients were intubated (13%) within 72 hours after the procedure. Hypotension was noted in 6.4% of patients. Conclusion Dexmedetomidine provided effective analgesia and facilitated laryngoscopy but did not consistently achieve mild sedation during LISA. While its safety profile was acceptable, a more rapid-onset sedative may be preferable for this procedure. Further randomized controlled trials are needed to establish an optimal sedation strategy for LISA in preterm newborns. Trial registration Register: ClinicalTrials.gov, number ID NCT04820101, enregistered 03-29-2021, https://clinicaltrials.gov/study/NCT04820101?cond=RDS&term=dexmedetomidine&rank=1#study-record-dates