Cerebroelectrical Depression Following Surfactant Treatment in Preterm Neonates

Abstract

During surfactant treatment of respiratory distress syndrome, 23 premature newborns were investigated with continuous amplitude-integrated electroencephalography (cerebral function monitors). Simultaneously, arterial blood pressure and transcutaneous blood gas values were recorded. A short(<10 minutes) but significant decrease in cerebral activity was seen in almost all neonates immediately after the surfactant instillation, in spite of an improved pulmonary function. In 21 of 23 neonates, a transient fall in mean arterial blood pressure of 9.3 mm Hg (mean) occurred coincidently with the cerebral reaction. Neonates in whom intraventricular hemorrhage developed tended to have lower presurfactant mean arterial blood pressure (P> .05), but they had a significantly lower mean arterial blood pressure after surfactant instillation (P < .05). No other differences were found between neonates in whom intraventricular hemorrhage developed and those without intraventricular hemorrhage. The present findings demonstrate that an acute cerebral dysfunction may occur after surfactant instillation. In some vulnerable neonates with arterial hypotension and severe pulmonary immaturity,the fall in mean arterial blood pressure may increase the risk of cerebral complications and could be related to an unchanged rate of intraventricular hemorrhage after surfactant treatment.

Cerebral oxygenation and bioelectrical activity in preterm infants during surfactant replacement therapy with porcine and bovine preparations

“…Interestingly, the use of poractant alfa, which has been reported previously to be clinically superior to beractant, led to more pronounced depression of the aEEG signal. Decrease of cerebral activity lasting up to 24 h despite improvement of pulmonary function after SRT has been reported before with various preparations and techniques of administration [ 5 – 8 ]. One of the proposed mechanisms leading to this phenomenon is a rapid decrease in pulmonary vascular resistance after SRT.…”

“…desaturation. It has been shown that surfactant replacement therapy (SRT) may cause acute changes in cerebral oxygenation and suppression of bioelectrical activity measured with amplitude-integrated electroencephalography (aEEG) [ 5 – 9 ]. Varying physiologic responses with different surfactant preparations have been observed in an animal model [ 9 ].…”

Newborns at high risk for brain injury: the role of the amplitude-integrated electroencephalography

“…Another common procedure that usually affects aEEG trace is surfactant administration, which often can lead to a noticeable but transient depression on brain activity lasting around ten minutes. 65 …”

Large Volume Surfactant Administration in Premature Infants Less Than 35 Weeks Using Minimally Invasive Surfactant Therapy

“…Although some studies suggested overall benefits of the InSurE procedure, 12 other studies failed to prove these benefits in that regard. 13…”

“…Although some studies suggested overall benefits of the InSurE procedure, 12 other studies failed to prove these benefits in that regard. 13 In view of this, different methods of MIST have been introduced for evaluation: intra-amniotic instillation, 14 pharyngeal instillations, 15 administrations via laryngeal mask airway (LMA), 16 and nebulized surfactant administration in spontaneously breathing infants. 17 Other types of MIST using tracheal catheterization were described; the surfactant is given to spontaneously breathing premature infants via feeding tube 18,19 or vascular catheter 20 placed in the trachea only during surfactant administration, and removed thereafter.…”