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NCT06150586 Clinical Trial

Pain Assessment During Less-Invasive-Surfactant-Administration

Pain Clinical Trial

— PALISA  

Official title:
The PALISA Study - Pain Assessment During Less-Invasive-Surfactant-Administration

Clinical Trial Details — Status: Recruiting

Administrative data
NCT number NCT06150586
Other study ID # PALISA
Secondary ID
Status Recruiting
Phase
First received
Last updated
Start date December 5, 2023
Est. completion date June 17, 2024

Study information
Verified date June 2024
Source University of Zurich
Contact Tobias Mühlbacher, MD
Phone +41 44 254 15 11
Email Tobias.Muehlbacher@usz.ch
Is FDA regulated No
Health authority
Study type Observational

Clinical Trial Summary

Primary aims of the study are to evaluate the feasibility of Skin conductance (SC) measurements and its correlation to Neonatal Pain and Distress Scale (N-PASS) - scores during the Less-Invasive-Surfactant-Administration (LISA)-procedure in preterm infants. Secondary aims are to evaluate the effect of LISA on the general stress-level in preterm infants with respiratory distress syndrome. The assessment of pain and stress with SC measurement in addition to the subjective assessment with N-PASS may provide more conclusive data on the sensation of pain or stress during the LISA procedure and therefore the necessity of analgosedation. Therefore, this study might help to identify those infants in need for analgosedation, which would allow an individualized approach in the future.

Recruitment information / eligibility
Status Recruiting
Enrollment 20
Est. completion date June 17, 2024
Est. primary completion date June 14, 2024
Accepts healthy volunteers
Gender All
Age group N/A to 48 Hours
Eligibility Inclusion Criteria: - Preterm infants =27 0/7 weeks of gestation at birth - Need for surfactant therapy via LISA according to the local standard operating procedure - =27 0/7 weeks of gestation, - within first 48 hours of life - FiO2 =0.30 to maintain SpO2 =90% for 15 min, - non-invasive respiratory support with PEEP 6-8 cmH2O - consent of attending NICU staff for videorecording Exclusion Criteria: - Primary intubation in the delivery room - Severe congenital malformation or other conditions requiring immediate endotracheal intubation - Insufficient language skills (German or English) of the parents to understand and consent the participation in the study.

Study Design

Related Conditions & MeSH terms

Intervention

Other:
• Skin Conductance (SC) Measurement
SC will be measured using a specific monitor and three self-adhesive electrodes on one foot of the infant (one plantar and two on the ankles). Peaks per second (the rate of firing in the sympathetic nerves), average amplitude (mean peaks) and area under curve (forcefulness of sympathetic nerve firing) will be automatically analyzed. Corresponding data will be transferred to a separate tablet computer via bluetooth.
• Video Recording
The video recording for later N-PASS assessment will be done by a camera fixed above the incubator / resuscitation unit, not interfering with the LISA procedure. The video will show the full body of the newborn as well as the hands / forearms of the treating clinical team with the awareness and oral consent of the treating team.

Locations
Country Name City State
Switzerland University Hospital Zurich Zürich

Sponsors (1)
Lead Sponsor Collaborator
University of Zurich

Country where clinical trial is conducted

Switzerland, 

References & Publications (8)

Hummel P, Lawlor-Klean P, Weiss MG. Validity and reliability of the N-PASS assessment tool with acute pain. J Perinatol. 2010 Jul;30(7):474-8. doi: 10.1038/jp.2009.185. Epub 2009 Nov 19. — View Citation

Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2008 Jan;28(1):55-60. doi: 10.1038/sj.jp.7211861. Epub 2007 Oct 25. — View Citation

Morgan ME, Kukora S, Nemshak M, Shuman CJ. Neonatal Pain, Agitation, and Sedation Scale's use, reliability, and validity: a systematic review. J Perinatol. 2020 Dec;40(12):1753-1763. doi: 10.1038/s41372-020-00840-7. Epub 2020 Oct 2. — View Citation

Munsters J, Wallstrom L, Agren J, Norsted T, Sindelar R. Skin conductance measurements as pain assessment in newborn infants born at 22-27 weeks gestational age at different postnatal age. Early Hum Dev. 2012 Jan;88(1):21-6. doi: 10.1016/j.earlhumdev.2011.06.010. Epub 2011 Jul 20. — View Citation

Peterson J, den Boer MC, Roehr CC. To Sedate or Not to Sedate for Less Invasive Surfactant Administration: An Ethical Approach. Neonatology. 2021;118(6):639-646. doi: 10.1159/000519283. Epub 2021 Oct 8. — View Citation

Storm H. Changes in skin conductance as a tool to monitor nociceptive stimulation and pain. Curr Opin Anaesthesiol. 2008 Dec;21(6):796-804. doi: 10.1097/ACO.0b013e3283183fe4. — View Citation

Storm H. Skin conductance and the stress response from heel stick in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2000 Sep;83(2):F143-7. doi: 10.1136/fn.83.2.f143. — View Citation

Tribolet S, Hennuy N, Snyers D, Lefebvre C, Rigo V. Analgosedation before Less-Invasive Surfactant Administration: A Systematic Review. Neonatology. 2022;119(2):137-150. doi: 10.1159/000521553. Epub 2022 Feb 4. — View Citation

Outcome
Type Measure Description Time frame Safety issue
Primary Median peaks per second at prespecified time-points adjusted for median peaks per second at baseline The prespecified time-points are:
baseline: before starting of interventions (2 minutes recording without any intervention);
insertion of nasopharyngeal tube;
insertion of laryngoscope for visualization of the vocal cords;
insertion of LISA catheter
administration of surfactant
removal of catheter
5 minutes after removal of catheter (2 minutes recording without any intervention)
1 hour (±10 minutes) after LISA (2 minutes recording without any intervention)		 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA
Secondary Median Neonatal Pain, Agitation and Sedation Scale (N-PASS) at prespecified time-points, adjusted for median N-PASS at baseline The N-PASS serves as a tool for evaluating pain and sedation levels in newborns. In the context of this study, the focus is solely on assessing pain. Five criteria, including crying, behavior, facial expression, extremity tone and vital signs, are rated on a scale of 0 to 2 points each. These individual scores are then added up to calculate a total pain score, which falls within the range of 0 to 10. A higher total score correlates with a higher level of perceived pain.
The prespecified time-points, at which the N-PASS will be assessed, are:
baseline: before starting of interventions
during insertion of laryngoscope for visualization of the vocal cords
administration of surfactant
5 minutes after removal of catheter
1 hour (±10 minutes) after LISA		 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA
Secondary Absolute number of apneas Absolute number of apneas requiring non-invasive pressure ventilation or increase of peak inspiratory pressure or frequency during the LISA procedure During LISA procedure
Secondary Absolute number of desaturations Absolute number of decreasing SpO2 requiring increase of FiO2 during the LISA procedure During LISA procedure
Secondary Absolute number of bradycardia Absolute number of bradycardia (<100/min) during the LISA procedure During LISA procedure
Secondary Absolute number of arterial hypotension Absolute number of arterial hypotension with mean blood pressure lower than gestational age during the LISA procedure During LISA procedure
Secondary Absolute number of blunt surfactant reflux Absolute number of blunt surfactant reflux seen in mouth or nose without laryngoscopy during the LISA procedure During LISA procedure
Secondary Difference in maximum peaks per second before and after apnea Difference in maximum peaks per second before and after apnea requiring non-invasive pressure ventilation or increase of peak inspiratory pressure or frequency during the LISA procedure During LISA procedure
Secondary Difference in median peaks per second during 20-second interval before and after apnea Difference in median peaks per second during 20-second interval before and after apnea requiring non-invasive pressure ventilation or increase of peak inspiratory pressure or frequency during the LISA procedure During LISA procedure
Secondary Difference in maximum peaks per second before and after desaturation Difference in maximum peaks per second before and after decreasing SpO2 requiring increase of FiO2 during the LISA procedure During LISA procedure
Secondary Difference in median peaks per second during 20-second interval before and after desaturation Difference in median peaks per second during 20-second interval before and after decreasing SpO2 requiring increase of FiO2 during the LISA procedure During LISA procedure
Secondary Difference in maximum peaks per second before and after bradycardia Difference in maximum peaks per second before and after bradycardia (<100/min) during the LISA procedure During LISA procedure
Secondary Difference in median peaks per second during 20-second interval before and after bradycardia Difference in median peaks per second during 20-second interval before and after bradycardia (<100/min) during the LISA procedure During LISA procedure
Secondary Difference in maximum peaks per second before and after arterial hypotension Difference in maximum peaks per second before and after arterial hypotension with mean blood pressure lower than gestational age during the LISA procedure During LISA procedure
Secondary Difference in median peaks per second during 20-second interval before and after arterial hypotension Difference in median peaks per second during 20-second interval before and after arterial hypotension with mean blood pressure lower than gestational age during the LISA procedure During LISA procedure
Secondary Difference in maximum peaks per second before and after blunt surfactant reflux Difference in maximum peaks per second before and after blunt surfactant reflux seen in mouth or nose without laryngoscopy during the LISA procedure During LISA procedure
Secondary Difference in median peaks per second during 20-second interval before and after blunt surfactant reflux Difference in median peaks per second during 20-second interval before and after blunt surfactant reflux seen in mouth or nose without laryngoscopy during the LISA procedure During LISA procedure
Secondary Difference in heart-rate between baseline and prespecified time-points as listed above. Difference in heart-rate between baseline and prespecified time-points as listed above 2 minutes before LISA, during LISA and 1 hour (±10 minutes) after LISA 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA
Secondary Difference in oxygen saturation between baseline and prespecified time-points as listed above. Difference in oxygen saturation between baseline and prespecified time-points as listed above 2 minutes before LISA, during LISA and 1 hour (±10 minutes) after LISA 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA
Secondary Difference in SpO2/FiO2-ratio between baseline and prespecified time-points as listed above. Difference in SpO2/FiO2-ratio between baseline and prespecified time-points as listed above 2 minutes before LISA, during LISA and 1 hour (±10 minutes) after LISA 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA
Secondary Difference of SpO2/FiO2-ratio compared to skin conductance peaks per second Difference of SpO2/FiO2-ratio at baseline, 5 minutes after removal of catheter and 60 minutes after LISA compared to skin conductance peaks per second (median peaks per second of 2 minute intervals). 2 minutes before LISA, 5 minutes after removal of catheter, 60 Minutes after LISA
Secondary LISA failure Incidence of LISA failure defined as intubation or repeated LISA within 24 hours Within 24 hours after LISA
Secondary Intubation <72 hours after the LISA procedure Incidence of intubation within <72 hours after the LISA procedure Within 72 hours after LISA
Secondary Air-leaks <72 hours after the LISA procedure Incidence of air-leaks within <72 hours after the LISA procedure Within 72 hours after LISA
Secondary Incidence of intraventricular hemorrhage Incidence of intraventricular hemorrhage at first ultrasound scan after 72 hours 72 hours after LISA
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