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Infant, Premature, DiseasesPALISANCT06150586

Pain Assessment During Less-Invasive-Surfactant-Administration

An observational study of Infant, Premature, Diseases and Respiratory Distress Syndrome, run by University of Zurich at 1 site in Switzerland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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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. Read more about this study

Who is it for?
Ages Up to 48 hours
What is being tested?
Skin Conductance (SC) Measurement and Video Recording
Type of treatment
Pill or oral medicine
How many people
21 participants
Where
1 siteSwitzerland
Study dates
5 Dec 2023to 17 Jun 2024
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages Up to 48 hours
  • All sexes
  • No healthy volunteers
  • Child

Study population: All preterm infants with ≥27 0/7 weeks of gestation at birth who meet the inclusion criteria and who do not fulfill the exclusion criteria

Who may be able to join

  • 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

Who cannot join

  • 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.

Trial locations and contacts

1 site in 1 country.

Switzerland1 site
  • University Hospital Zurich

    Zurich, CH-8091

Other trials in Switzerland

About this study

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

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.

Being tested
Skin Conductance (SC) Measurement, Video Recording
Keywords
Less-Invasive-Surfactant-Administration, Skin Conductance, Neonatal Pain and Sedation Scale, Analgosedation, General stress-level
Medical subject headings
Infant, Premature, Diseases, Respiratory Distress Syndrome, Pulmonary Atelectasis, Pain

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Skin Conductance (SC) MeasurementOther

    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 RecordingOther

    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.

Study groups in NCT06150586
Study groupRoleWhat they receive
Preterm infants with minimal gestational age of 27 weeks requiring LISALISA will be preformed according to our local standard protocol while measuring skin conductance via a specific monitor. At the same time a video is recorded for later unblinded and blinded N-PASS assessment.
Receives: Other: Skin Conductance (SC) Measurement; Other: Video Recording

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Median peaks per second at prespecified time-points adjusted for median peaks per second at baseline

    The prespecified time-points are:

    1. baseline: before starting of interventions (2 minutes recording without any intervention);
    2. insertion of nasopharyngeal tube;
    3. insertion of laryngoscope for visualization of the vocal cords;
    4. insertion of LISA catheter
    5. administration of surfactant
    6. removal of catheter
    7. 5 minutes after removal of catheter (2 minutes recording without any intervention)
    8. 1 hour (±10 minutes) after LISA (2 minutes recording without any intervention)

    Measured: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA

Secondary outcomes (24)
  1. 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:

    1. baseline: before starting of interventions
    2. during insertion of laryngoscope for visualization of the vocal cords
    3. administration of surfactant
    4. 5 minutes after removal of catheter
    5. 1 hour (±10 minutes) after LISA

    Measured: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA

  2. 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

    Measured: During LISA procedure

  3. Absolute number of desaturations

    Absolute number of decreasing SpO2 requiring increase of FiO2 during the LISA procedure

    Measured: During LISA procedure

  4. Absolute number of bradycardia

    Absolute number of bradycardia (<100/min) during the LISA procedure

    Measured: During LISA procedure

  5. Absolute number of arterial hypotension

    Absolute number of arterial hypotension with mean blood pressure lower than gestational age during the LISA procedure

    Measured: During LISA procedure

  6. Absolute number of blunt surfactant reflux

    Absolute number of blunt surfactant reflux seen in mouth or nose without laryngoscopy during the LISA procedure

    Measured: During LISA procedure

  7. 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

    Measured: During LISA procedure

  8. 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

    Measured: During LISA procedure

  9. 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

    Measured: During LISA procedure

  10. 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

    Measured: During LISA procedure

  11. 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

    Measured: During LISA procedure

  12. 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

    Measured: During LISA procedure

  13. 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

    Measured: During LISA procedure

  14. 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

    Measured: During LISA procedure

  15. 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

    Measured: During LISA procedure

  16. 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

    Measured: During LISA procedure

  17. 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

    Measured: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA

  18. 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

    Measured: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA

  19. 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

    Measured: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA

  20. 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).

    Measured: 2 minutes before LISA, 5 minutes after removal of catheter, 60 Minutes after LISA

  21. LISA failure

    Incidence of LISA failure defined as intubation or repeated LISA within 24 hours

    Measured: Within 24 hours after LISA

  22. Intubation <72 hours after the LISA procedure

    Incidence of intubation within <72 hours after the LISA procedure

    Measured: Within 72 hours after LISA

  23. Air-leaks <72 hours after the LISA procedure

    Incidence of air-leaks within <72 hours after the LISA procedure

    Measured: Within 72 hours after LISA

  24. Incidence of intraventricular hemorrhage

    Incidence of intraventricular hemorrhage at first ultrasound scan after 72 hours

    Measured: 72 hours after LISA

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted29 Nov 2023
  2. Study start5 Dec 2023
  3. Primary completion14 Jun 2024
  4. Study completion17 Jun 2024

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
21 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06150586
Sponsor's protocol ID
PALISA
Acronym
PALISA
Status last verified
Feb 2026
First submitted
20 Nov 2023
Last updated
10 Feb 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • 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.

    PubMed 34628413
  • 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.

    PubMed 35124678
  • 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.

    PubMed 18165830
  • 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.

    PubMed 19924132
  • 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.

    PubMed 21764228
  • 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.

    PubMed 10952711
  • 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.

    PubMed 18997532
  • 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.

    PubMed 33009491
  • Dirler C, Boos V, Bassler D, Benke-Bruderer S, Held U, Ruegger CM, Muehlbacher T. Pain Assessment During Less Invasive Surfactant Administration Using Skin Conductance: A Prospective Cohort Study. Pediatr Res. 2025 Dec 22. doi: 10.1038/s41390-025-04703-9. Online ahead of print.

    PubMed 41429954

Questions about this trial

What is this clinical trial studying?

An observational study of Infant, Premature, Diseases and Respiratory Distress Syndrome, run by University of Zurich at 1 site in Switzerland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 7 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Feb 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Switzerland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Median peaks per second at prespecified time-points adjusted for median peaks per second at baseline (time frame: 2 minutes before LISA, during LISA, 1 hour (±10 minutes) after LISA). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT06150586, which also lists 9 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Feb 2026.

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