Sevoflurane for Short Painful Procedures in the Neonatal Intensive Care Unit.

OBJECTIVE: The aim of this study is to evaluate the use and safety of a sedation protocol with sevoflurane for short painful procedures in newborns. STUDY DESIGN: This was a prospective and observational study conducted in a tertiary neonatal intensive care unit. Sevoflurane was recommended in patients undergoing an invasive procedure of short length, especially in those with spontaneous breathing or without venous access. Its safety and efficacy was assessed by continuous monitoring of respiratory and hemodynamic variables and clinical data recording. RESULTS: Sevoflurane was used for 39 procedures, the main indications were: intravitreal bevacizumab injection (12), central venous catheterization (11), and biopsy (6). The median administration length was 14 minutes (range: 5-65 minutes). The median minimum dose was 1.5% (range: 1-3%). The median maximum dose was 2.5% (range: 1-6%). An effective control of nociceptive manifestations was achieved in 35 cases (90%). No major adverse effects were noticed. Main adverse effects were hypotension (8), desaturation (4), and apnea (3). All of them were solved by decreasing (14) or discontinuing (1) the administration of sevoflurane. CONCLUSION: Sevoflurane is relatively easy to use and provides an optimal control of pain-related symptoms. Its prescription should be individualized and more long-term follow-up data are needed.

Underdosing of Surfactant for Preterm Babies with Respiratory Distress Syndrome in Clinical Practice: A Retrospective Cohort Study.

OBJECTIVE: To evaluate the initial doses of surfactant administered to preterm infants with respiratory distress syndrome. STUDY DESIGN: This is a retrospective cohort study of 206 preterm infants admitted in four level III neonatal intensive care units of acute tertiary care hospitals in Spain between 2013 and 2015. RESULTS: The mean initial dose of surfactant was 173.9 (37.3) mg/kg, and 47.5% of infants received a dose of 200 mg/kg ± 10% (180-220 mg/kg), 47% less than 180 mg/kg (-10%), and 5.4% more than 220 mg/kg (+10%). Very preterm infants (<28 weeks) received higher initial doses than more mature infants, but in all cases, the mean doses were below the recommended 200 mg/kg (by 9.2% in gestational age 23-28 weeks, by 15.9% in 29-32 weeks, and by 24.3% in >32 weeks). CONCLUSION: Administration of surfactant below the prescribed dose is a frequent error in clinical practice. Inadvertently rounding down doses seems a plausible explanation.