The Effect of Continuous PEEP Administration during Surfactant Instillation on Cerebral Hemodynamics in Intubated Preterm Infants: A NIRS Study

Abstract

Objective There is an ongoing debate about the best and comfortable way to administer surfactant. We hypothesized that uninterrupted respiratory support and continuous PEEP implementation while instilling surfactant via endotracheal tube (ETT) with side port will result in higher regional cerebral tissue oxygenation (rcSO2) and the alterations in cerebral hemodynamics will be minimal.

Study Design Preterm infants who required intubation in the delivery room and/or in the first 24 hours of life with gestational age <32 were enrolled. Patients were intubated either via conventional ETT or ETT with side port (Vygon) with appropriate sizes. Following neonatal intensive care unit admission a near-infrared spectroscopy (NIRS) probe was placed on the forehead and each infant was started to be monitored with NIRS. In conventional ETT group, patients separated from the ventilator while surfactant was instilled. In ETT with side port group, respiratory support was not interrupted during instillation. Heart rate, oxygen saturation, rcSO₂, cerebral fractional tissue oxygen extraction (cFTOE), and blood pressures were recorded.

Results A total of 46 infants were analyzed. Surfactant was instilled with conventional ETT in 23 and ETT with side port in 23 infants. Birth weights (1,037 ± 238 vs. 1,152 ± 277 g) and gestational ages (28 ± 2.3 vs. 29 ± 1.6 weeks) did not differ between groups. During instillation of surfactant, rcSO2 levels [61.5 (49–90) vs. 70 (48–85)] and cFTOE levels 0.28 (0.10–0.44) vs. 0.23 (0.03–0.44)] were similar (p = 0.58 and 0.82, respectively).

Conclusion Interruption of respiratory support during surfactant instillation did not significantly alter the cerebral tissue oxygenation. These results did not support our hypothesis and should be confirmed with further studies.

Key Points

• Monitoring intracerebral oxygenation changes during surfactant administration with NIRS is feasible.

• The surfactant administration method does not significantly alter the cerebral oxygenation.

• Surfactant administration itself rather than the method caused a transient drop in cerebral NIRS readings.

Keywords

cerebral oxygenation - premature - surfactant instillation - NIRS

Authors' Contributions

N.O. had primary responsibility for protocol development and analytic framework of the study, outcome assessment, and manuscript preparation. H.B. and G.K.K. participated in the development of the protocol and analytic framework of the study, had primary responsibility for the review of the files, patient screening, enrollment, and data entry, and prepared the manuscript with N.O. M.B., F.E.C., G.K.S., and S.S.O. contributed to the preparation and revision of the manuscript.

Publication History

Received: 23 June 2021

Accepted: 26 September 2021

Accepted Manuscript online:
28 September 2021

Article published online:
19 October 2021

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