A neonatal audit’s high completion rate did not mean that less-invasive surfactant administration occurred without physiological events.
One hundred twenty neonates received routine midazolam premedication before less-invasive surfactant administration at a UK center. Operators judged 119 procedures successful. Among the reported events were desaturation below 80% in 47.1%, apnea in 24.4% and bradycardia in 16.0%. Nine of 119 infants required intubation and ventilation within twenty-four hours.
This was a single-center prospective audit without a no-premedication or alternative-drug comparator. Success was partly operator-defined. The procedure and underlying respiratory disease can also produce physiological changes, so the audit cannot assign each event to midazolam or establish a causal increase in intubation.
For neonatal expert review, report both successful surfactant delivery and the actual event definitions and frequencies. A favorable overall description should not obscure transient respiratory instability. Conversely, an event occurring after premedication is not automatically drug-caused. The record must show baseline support, timing, interventions and subsequent course.
Source reviewed: Midazolam as premedication for less invasive surfactant administration a prospective single centre a (PMC13052648). Forensic applications above are interpretive analysis of the supplied paper.
Related reading: Neonatal Midazolam–Fentanyl Comparison Had No Long-Term Developmental Follow-Up.