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
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Monitoring intracerebral oxygenation changes during surfactant administration with
NIRS is feasible.
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The surfactant administration method does not significantly alter the cerebral oxygenation.
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Surfactant administration itself rather than the method caused a transient drop in
cerebral NIRS readings.
Keywords
cerebral oxygenation - premature - surfactant instillation - NIRS
