Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

The goal of a prospective observational study was to assess pain and physiological stress in very preterm neonates undergoing minimally invasive surfactant therapy (MIST) in a tertiary Neonatal Intensive Care Unit (NICU). The Premature Infant Pain Profile-Revised (PIPP-R) score was used to evaluate pain levels before, during, and after MIST. Changes in heart rate and oxygen saturation were also recorded during the procedure.

Overall, 23 neonates received MIST. The mean PIPP-R score during MIST was 3.87 (before), 12.83 (during), and 6.26 (after) the procedure – with all differences being statistically significant. Additionally, heart rate and oxygen saturation decreased significantly during MIST. 

In conclusion, the high PIPP-R scores observed during surfactant administration through MIST indicate that this procedure can cause moderate to severe pain/discomfort and significant physiological stress in very preterm infants. 

The findings suggest the need for further research, including a large randomized controlled trial, to evaluate the potential benefits of sedation/analgesia in reducing pain and physiological stress during MIST, weighing these benefits against the potential risks of complications like respiratory depression and chest wall rigidity that may necessitate increased respiratory support during or after the procedure. 

Source: Sawant T, Manerkar S, Patra S, Kalamdani P, Kalathingal T, Mondkar J. Indian Pediatrics. 2023 Jul;60(7):557-60.