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

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 (rSO(2)C) 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 (T2T2), 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 SpO(2) 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. rSO(2)C 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 rSO(2)C 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.