Change of Cerebral Oxygenation during Surfactant Treatment in Preterm Infants: “LISA” versus “InSurE” Procedures

Abstract

Objectives The aim of the study was to compare the effects on cerebral oxygenation in preterm infants of two different procedures for surfactant administration: the LISA (low-invasive method of surfactant administration) and the InSurE (Intubation, SURfactant administration, Extubation).

Study Design Twenty premature infants with respiratory distress syndrome were assigned to receive surfactant either by “LISA” (n = 10) or “InSurE” (n = 10) procedure. Patients were continuously studied by near-infrared spectroscopy (NIRS) for the measurement of cerebral regional oxygenation (rSO₂C) and calculation of cerebral fractional oxygen extraction rate (cFTOE), and NIRS data were recorded 30 minutes before (T ₀) surfactant administration, during the procedure (T _proc), and 30 (T ₁), 60 (T ₂ T ₂), and 120 minutes (T ₃) afterward. Cerebral blood flow velocity (CBFV) was studied in the anterior cerebral artery at T ₀, T ₁, and T ₃.

Results SpO₂ significantly decreased at T _proc in comparison with T ₀, T ₁, T ₂, and T ₃ and the decrease was higher in the LISA than in the InSurE group. rSO₂C was lower at t _proc and T ₃ in the LISA than in the InSurE group. cFTOE was higher at t _proc, t ₂, and t ₃ in the LISA group than in the InSurE group. CBFV did not change during the study periods in both groups.

Conclusions The LISA and InSurE procedures transiently decreased rSO₂C in our population, and the decrease was higher in the LISA group. Consistently, there was a contemporary increase in cFTOE that was higher in the LISA than in the InSurE group, suggesting that it represents a compensatory mechanism.

Keywords

surfactant administration - premature infants - NIRS

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