Intranasal Midazolam Premedication for Digital Image-Assisted Fundus Examination in Preterm Neonates

Objective We aimed to evaluate the feasibility and tolerability of fundus examination in preterm newborns after implementing a premedication with intranasal midazolam as a quality improvement project in a neonatal intensive care unit (NICU). Study Design Prospective examination of all fundus examinations between January and June 2022, before 0 (T0) and after 1 (T1), 15 (T15), and 60 (T60) minutes from intranasal midazolam administration. The EDIN (Echelle de Douleur et Incomfort du Nouveau-n & eacute; [newborn pain and discomfort score & mdash;in French]) pain score was calculated and various physiologic parameters were recorded. Data were analyzed with repeated measures ANOVA (analysis of variance). Results A total of 36 fundus examinations were performed in 27 noninvasively ventilated patients. The mean EDIN score went from 0.8 +/- 1 at T0 to 0.72 +/- 1.05 at T1, then to 0.22 +/- 0.59 at T15, and to 0 +/- 0 at T60 (p < 0.001). Thus, it remained below the threshold of 5, which is associated with significant pain. The mean heart rate decreased from 164 +/- 16 at T0, to 161 +/- 16 at T1, then to 154 +/- 14 at T15, and to 153 +/- 12 at T60 (p < 0.001). There was no significant change in the oxygen saturation/inspired oxygen fraction ratio across the four time points (p= 0.202) and the mean arterial pressure was similar before and after the administration of midazolam (60 +/- 10 vs. 59 +/- 10, p= 0.571). Conclusion Intranasal midazolam provides good comfort and normal physiological parameters; therefore, the implementation of a NICU protocol to improve quality of retinal examinations seems feasible and well tolerated.

Automated summary

This study evaluated the feasibility and tolerability of using intranasal midazolam to improve fundus examination in a neonatal intensive care unit. The results showed that intranasal midazolam provided good comfort and normal physiological parameters. Therefore, it can be implemented as a protocol to improve the quality of retinal examinations.