Résumé
Introduction: less invasive surfactant administration (LISA) limits tracheal invasive ventilation in premature infants but adequate premedication which preserves respiratory function needs to be evaluated. The aim of this study was to compare the efficacy and tolerance of intravenous administration of ketamine or propofol. Methods: we retrospectively included premature infants with respiratory distress syndrome below 30 weeks of gestational age (wGA), hospitalised in the neonatal intensive care unit of Montpellier treated with LISA procedure. -Primary outcome: comparison of the intubation rate within 2 hours following intravenous ketamine versus propofol administration. -Secondary outcomes: intubation rate within 24 and 72hours, pain scores, haemodynamic tolerance and morbi-mortality. Results: 77 infants were included from January 2016 to February 2019, with a mean (SD) wGA and birth weight of 27 (1.4) and 990 (265) g. LISA in ketamine and propofol group was performed at (70(95) vs 62(97) min; p=0.72). The intubation rate within 2 hours was similar (4/50(8) vs 2/27(7)). Mean total doses used were 1 mg/kg and 1.2 mg/kg respectively. Intubation rate at 24 and 72hours, mean arterial blood pressure measures over the first 30 minutes were not different. In the ketamine group, the dose received was higher in the group which was intubated within the first 72h compared with the one which was not intubated (1,3mg/kg versus 0,8mg/kg; p=0.04). Conclusion: in our population, efficacy and tolerance during LISA procedure seemed to be comparable with a low-dose of ketamine or propofol premedication. This study suggests that the dose of ketamine should be carefully considered.