Effect of the "InSurE" procedure on cerebral oxygenation and electrical brain activity of the preterm infant.
BACKGROUND
In preterm infants with respiratory distress syndrome (RDS) nasal continuous positive airway pressure (nCPAP) with the "InSurE" procedure (intubation, surfactant, extubation) is increasingly used. However, its effect on cerebral oxygenation and brain function is not known.


OBJECTIVE
To evaluate the effects of the "InSurE" procedure in infants with RDS on regional cerebral oxygen saturation (rScO(2)) and relative cerebral fractional tissue oxygen extraction (cFTOE) using near infrared spectroscopy and on electrical brain activity using amplitude-integrated electroencephalography (aEEG).


METHODS
Sixteen infants with RDS, treated with the "InSurE" procedure, and 16 matched controls with nCPAP, were monitored for mean arterial blood pressure (MABP), arterial oxygen saturation (SaO(2)), rScO(2), cFTOE and aEEG. Ten-minute periods were selected and averaged at 120 and 20 minutes before, during the procedure and at 30 minutes, 1, 2, 6, 12 and 24 h after the start of the "InSurE" procedure. aEEG was analysed by quantitative and qualitative (Burdjalov score) methods.


RESULTS
MABP was not different between groups on all time points. rScO(2) and cFTOE were comparable between groups, but there was a trend towards lower rScO(2) and higher cFTOE 30 minutes after opioid administration in the "InSurE" infants compared with controls (62% (SD 11) vs 68% (SD 10) and 0.30 (SD 0.10 ) vs 0.28 (SD 0.11), respectively). aEEG amplitudes and Burdjalov scores were significantly lower in "InSurE" infants from 30 minutes after opioid administration up to 24 h after the start of the procedure (p<0.05).


CONCLUSIONS
In the present study, the "InSurE" procedure did not induce perturbation of cerebral oxygen delivery and extraction, whereas electrical brain activity decreased for a prolonged period of time.
van den Berg
E
E
Department of Neonatology, Room KE.04.123.1, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands.
Lemmers
P M A
PM
Toet
M C
MC
Klaessens
J H G
JH
van Bel
F
F
D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D001921:Brain / Q000378:metabolism*; D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure / Q000379:methods; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007442:Intubation, Intratracheal; D008297:Male; D008991:Monitoring, Physiologic; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D011663:Pulmonary Surfactants / Q000008:administration & dosage*; D012127:Respiratory Distress Syndrome, Newborn / Q000378:metabolism / Q000628:therapy*; D019265:Spectroscopy, Near-Infrared / Q000379:methods
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D011663:Pulmonary Surfactants; D009270:Naloxone; D010100:Oxygen