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Should premedication be used for less invasive surfactant administration (LISA)?
  1. Rachel Yew,
  2. Michelle Fleeman,
  3. Harsha Gowda
  1. Neonatal Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Rachel Yew, Neonatal Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; rachelyew{at}

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A 30-week gestation premature infant with respiratory distress syndrome is currently on non-invasive ventilation requiring 40% fraction of inspired oxygen (FiO2). A clinical decision was made to administer surfactant via the less invasive surfactant administration (LISA) technique. Should premedication be given prior to the procedure?

Structured clinical question

During LISA in neonates (patient), is the use of premedication (intervention) if compared with performing LISA without the use of premedication (comparator) associated with increased comfort and increased chance of successful procedure without increasing the risk of complications of desaturations, bradycardia and apnoea (outcome)?


A literature search was performed via Medline, Ovid Embase, CINAHL and Cochrane library using the keywords “less invasive surfactant administration”, “LISA”, “sedation”, “pre-medication”, “minimally invasive surfactant therapy” and “MIST”. The search was carried out until the 24 March 2022. There were 46 articles identified from the literature search and 6 articles were found to be relevant and useful as these articles looked at the relevant outcomes.


LISA is an effective way to administer surfactant in a spontaneously breathing infant with respiratory distress syndrome, with the aim to avoid mechanical ventilation. Studies have shown that LISA reduces the incidence of bronchopulmonary dysplasia.1 However, how LISA is delivered in practice, particularly with regard to premedication use during LISA, remains variable.2 The …

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  • Contributors All authors were involved in the evidence search and the writing of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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