Ellen de Kort

64 Chapter 4 Second limitation is the lack of vital parameter data in 59% of included patients. Patients with available data had significantly higher gestational and postnatal ages compared to patients in whom vital parameter data were not available. Since we found no influence of gestational and postnatal age on the success rate and technical quality, we would not expect the effects of awake LISA on vital parameters to be different in younger compared to older infants. The availability of vital parameter data in only a small proportion of patients, therefore, will most likely not have affected the validity of our findings. Other limitations are the lack of blood pressure data, which could have helped make a distinction between atropine effect and stress in patients with a significant elevation of heart rate, and the lack of objective measurements of pain and discomfort. CONCLUSION In our study of LISA procedures performed without sedative premedication, the success rate of the first attempt was only 52%, the technical quality was frequently inadequate, and there was a high incidence of oxygen desaturations. Although providing patient comfort should be a key factor in neonatology, the adverse effects of performing LISA without premedication should be carefullyweighed against the negative effects and risks of administering sedative premedication before LISA. Other forms of premedication with lesser effect on the respiratory drive need to be investigated. The use of atropine during LISA resulted in a very low incidence of bradycardia and should therefore be strongly considered, regardless of the use of sedative premedication.