[Comparison of effects of endotracheal suction and surfactant administration on hemodynamics and oxygenation of premature infants--a near infrared spectroscopy study].
BACKGROUND
Aim of this study was to assess whether the decrease in heart rate and oxygen saturation occurring acutely after bolus administration of surfactant is different from the effect of endotracheal suctioning and whether there are effects on cerebral haemodynamics and oxygenation.


METHODS
Twelve premature infants, birth weight 720-1560 g (Median 935 g), gestational age 25-30 weeks (Median 28 weeks), were investigated during surfactant administration (Curosurf) as a single bolus and a preceding endotracheal suctioning procedure. Using near infrared spectroscopy changes in cerebral blood volume and cerebral oxygenation index were assessed. Heart rate, arterial oxygen saturation, PCO2, and arterial blood pressure were registered continuously. Data were compared at 30, 60 and 120 seconds after the beginning of suctioning and surfactant administration.


RESULTS
Endotracheal suctioning and surfactant administration induced a similar decrease in heart rate (-29/min, SD 25, p < 0.01 and -30/min, SD 23, p < 0.001) during the first 30 seconds and in oxygen saturation at the 30 seconds datapoint (-3%, SD 2, p < 0.01 and -3%, SD 6, p < 0.05). The decrease in oxygen saturation persisted at 60 seconds after the start of suctioning (-4%, SD 5, p < 0.05). In contrast, oxygen saturation was no longer different from baseline levels 60 seconds after surfactant administration (+1%, SD 6, p = 0.5). After suctioning, cerebral oxygenation index had decreased significantly from baseline levels at 30, 60, and 120 seconds. In contrast, after surfactant administration, no significant difference from baseline was noted at 30 and 60 seconds and a significant increase occurred at 120 seconds. Mean arterial blood pressure, PCO2, and cerebral blood volume did not change significantly during endotracheal suctioning and during surfactant administration.


CONCLUSIONS
Acute decreases in heart rate and oxygen saturation during bolus administration of surfactant are equal to effects occurring during endotracheal suctioning. However, the decrease in oxygen saturation is shorter and more importantly, no decrease in cerebral oxygenation occurs.
Roll
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C
Abteilung Allgemeine Kinderheilkunde, Klinik- und Poliklinik für Kinder- und Jugendmedizin, Universität GHS, Essen. claudia.roll@uni-essen.de
Horsch
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S
Knief
J
J
Hüsing
J
J
Hanssler
L
L
D001688:Biological Products; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D001921:Brain / Q000098:blood supply; D002245:Carbon Dioxide / Q000097:blood; D005260:Female; D006339:Heart Rate / Q000187:drug effects / Q000502:physiology; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008297:Male; D010100:Oxygen / Q000097:blood*; D010101:Oxygen Consumption / Q000187:drug effects / Q000502:physiology; D010743:Phospholipids; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012016:Reference Values; D012127:Respiratory Distress Syndrome, Newborn / Q000188:drug therapy* / Q000503:physiopathology; D019265:Spectroscopy, Near-Infrared; D013396:Suction
D001688:Biological Products; D010743:Phospholipids; D011663:Pulmonary Surfactants; D002245:Carbon Dioxide; C068291:poractant alfa; D010100:Oxygen