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 (T₀) surfactant administration, during the procedure (T_proc), and 30 (T₁), 60 (T₂T₂), and 120 minutes (T₃) afterward. Cerebral blood flow velocity (CBFV) was studied in the anterior cerebral artery at T₀, T₁, and T₃. Results SpO₂ significantly decreased at T_proc in comparison with T₀, T₁, T₂, and T₃ and the decrease was higher in the LISA than in the InSurE group. rSO₂C was lower at t_proc and T₃ in the LISA than in the InSurE group. cFTOE was higher at t_proc, t₂, and t₃ 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.