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. 2025 Mar;27(2):247-255.
doi: 10.1007/s40272-024-00667-1. Epub 2024 Nov 22.

Dexmedetomidine for Less Invasive Surfactant Administration: A Pilot Study

Sagee Nissimov  1   2 , Amitai Kohn  3 , Rimona Keidar  3   4 , Ayelet Livne  3 , Mazal Shemer  3 , Ayala Gover  5   6 , Calanit Hershkovich-Shporen  7 , Matitiahu Berkovitch  4   8 , Iris Morag  3   4
Affiliations

Dexmedetomidine for Less Invasive Surfactant Administration: A Pilot Study

Sagee Nissimov et al. Paediatr Drugs. 2025 Mar.

Abstract

Introduction: Less invasive surfactant administration (LISA) involves delivering surfactant to a spontaneously breathing infant by passing a thin catheter through the vocal cords and has become the preferred method for surfactant delivery. However, the role of pre-LISA sedation remains unclear.

Objective: The aim of this study was to describe the use of dexmedetomidine for LISA in preterm and early-term infants.

Methods: This retrospective study evaluated preterm and early-term infants who received intravenous dexmedetomidine for LISA between December 2022 and March 2024. Primary outcomes included safety parameters such as the absence of bradycardia, hypotension, hypothermia, or respiratory depression, and the success rate of LISA, determined by the lack of endotracheal intubation within 72 h. Intergroup comparison based on a cutoff of 32 weeks post-menstrual age (PMA) was performed.

Results: Thirty-seven infants were included. The mean ± SD PMA at birth, birth weight, and age at LISA were 32.2 ± 2.7 weeks, 1879 ± 698 g, and 13.9 ± 12.4 h, respectively. Mean dexmedetomidine dosage was 0.66 ± 0.26 μg/kg. Six patients (16.2%) developed mild hypothermia, and 10 (27%) experienced apnea/bradycardia within 24 h. The success rate of the procedure was 89.2%. Infants born before 32 weeks received lower doses of dexmedetomidine than those born at 32 weeks and above (0.54 ± 0.24 versus 0.76 ± 0.24 μg/kg, p < 0.01). Safety and success rates of LISA were similar across groups.

Conclusion: This is the first report on dexmedetomidine as pre-LISA sedation, demonstrating its feasibility with comparable success rates regardless of PMA. These findings may inform future studies on sedation strategies for LISA.

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Conflict of interest statement

Declarations. Funding: The authors have no relevant financial interests to disclose. This research received no specific grant from any funding agency. Conflict of interest: Sagee Nissimov, Amitai Kohn, Rimona Keidar, Ayelet Livne, Mazal Shemer, Ayala Gover, Calanit Hershkovich-Shporen, Matitiahu Berkovitch, and Iris Morag declare that they have no potential conflicts of interest that might be relevant to the contents of this manuscript. Ethics approval: Research ethics approval for the study was obtained from Shamir Medical Center in accordance with the Declaration of Helsinki (approval number 0056-24-ASF). Consent to participate: Due to the fact that dexmedetomidine has been utilized as a primary pre-LISA sedative in our unit since December 2022, informed consent for this retrospective study was waived. Data availability statement: Data analyzed during this study are included in this published article as supplementary information files. Additional patients’ data are available from the corresponding author on request. Author contributions: Dr Sagee Nissimov and Prof. Iris Morag conceived, designed, and planned the study, contributed to data extraction, and interpretation of results, wrote the first and final draft of the manuscript, and approved the final publication. Drs Amitai Kohn, Rimona Keidar, Ayelet Livne, and NP Mazal Shemer assisted in the extraction of data, and contributed to and approved the final publication. Drs Ayala Gover, Calanit Hershkovich-Shporen and Prof. Matitiahu Berkovitch contributed to study design and data analysis and contributed to and approved the final publication.

Comment in

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