Pain Assessment During Less Invasive Surfactant Administration Using Skin Conductance: A Prospective Cohort Study

Background: Less Invasive Surfactant Administration (LISA) is an established treatment for surfactant deficiency. However, analgosedation for LISA remains controversial. The aim of this study was to assess pain using skin conductance (SC) measurements during LISA. Methods: This prospective cohort study included preterm infants born at ≥27 weeks. Pain was assessed using SC and blinded Neonatal Pain, Agitation and Sedation Scale (N-PASS) scoring. Primary outcome was change to baseline in SC peaks per second (PPS) at pre-specified events. Secondary outcomes included N-PASS scores and changes in cardiorespiratory parameters. Results: Twenty infants were included in the analysis. SC-PPS were increased during nasopharyngeal tube (NPT) insertion, but no more significant after adjusting for chronological age. SC-PPS were not increased at any other pre-specified event during LISA. N-PASS scores indicated elevated pain levels during NPT insertion (Δ = 3.28, 95%-CI: 1.37 to 5.20) and laryngoscopy (Δ = 3.60, 95%-CI 1.77 to 5.43). SC and N-PASS scores showed a weak correlation (Kendall's τ = 0.17; 95%-CI: 0.02 to 0.31). Conclusion: LISA was not associated with elevated SC-PPS, despite increased N-PASS scores during specific procedural steps. This may reflect technical limitations of SC monitoring immediately after birth in preterm infants. Clinical trial registration: ClinicalTrials.gov (NCT06150586) IMPACT: Skin conductance (SC) measurement has been proposed as an objective method for pain assessment in preterm infants. In our study, SC did not indicate a pain response in infants undergoing Less Invasive Surfactant Administration (LISA). Our findings suggest that SC alone may not be a reliable indicator of procedural pain in preterm infants shortly after birth. There remains a critical need for objective methods to assess pain in preterm infants. Further research is required to validate SC for neonatal pain assessment.