INTRODUCTION This study was set up to investigate if and to what extent non-pharmacological analgesia is able to provide comfort to very preterm infants (VPI) during less invasive surfactant administration (LISA). METHODS This was a prospective non-randomized multicenter observational study performed in level IV NICUs. Inborn VPI with a gestational age between 220/7 and 316/7 weeks, signs of respiratory distress syndrome, and the need for surfactant replacement were included. Non-pharmacological analgesia was performed in all infants during LISA. In case of failure of the first LISA attempt, additional analgosedation could be administered. COMFORTneo scores during LISA were assessed. RESULTS 113 VPI with a mean gestational age of 27 weeks (+/- 2.3 weeks) and mean birth weight of 946 g (+/- 33 g) were included. LISA was successful at the first laryngoscopy attempt in 81%. COMFORTneo scores were highest during laryngoscopy. At this time point, non-pharmacological analgesia provided adequate comfort in 61% of the infants. 74.4% of lower gestational aged infants (i.e., 220-266 weeks) were within the comfort zone during laryngoscopy compared to 51.6% of higher gestational aged infants (i.e., 270-320 weeks) (p = 0.016). The time point of surfactant administration did not influence the COMFORTneo scores during the LISA procedure. CONCLUSION Non-pharmacological analgesia provided comfort in as much as 61% of the included VPI during LISA. Further research is needed to both develop strategies to identify infants who, despite receiving non-pharmacological analgesia, are at high risk for experiencing discomfort during LISA and define patient-tailored dosage and choice of analgosedative drugs.

中文翻译：

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极早产儿微创表面活性剂给药期间的舒适度评估：一项多中心研究。

引言 本研究旨在调查非药物镇痛是否以及在多大程度上能够在微创表面活性剂给药 (LISA) 期间为极早产儿 (VPI) 提供舒适感。方法 这是一项在 IV 级 NICU 中进行的前瞻性非随机多中心观察研究。孕龄在 220/7 至 316/7 周之间的先天 VPI、呼吸窘迫综合征的体征以及需要表面活性剂替代的情况均包括在内。LISA 期间所有婴儿均进行非药物镇痛。如果第一次 LISA 尝试失败，可以给予额外的镇静剂。对 LISA 期间的 COMFORTneo 评分进行了评估。结果 纳入 113 名平均孕龄为 27 周（+/- 2.3 周）、平均出生体重为 946 克（+/- 33 克）的 VPI。LISA 第一次喉镜检查的成功率为 81%。COMFORTneo 评分在喉镜检查期间最高。此时，非药物镇痛为 61% 的婴儿提供了足够的舒适感。74.4% 的低胎龄婴儿（即 220-266 周）在喉镜检查期间处于舒适区，而高胎龄婴儿（即 270-320 周）的这一比例为 51.6% (p = 0.016)。表面活性剂给药的时间点不影响 LISA 手术期间的 COMFORTneo 评分。结论 在 LISA 期间，非药物镇痛为多达 61% 的 VPI 提供了舒适感。需要进一步的研究来制定策略来识别尽管接受非药物镇痛但在 LISA 期间经历不适的高风险的婴儿，并确定患者定制的剂量和镇静药物的选择。