Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants

Kaiser, Jeffrey R.; Gauss, C. Heath; Williams, David

doi:10.1016/j.jpeds.2004.03.022

Cited by 47 publications

(59 citation statements)

References 29 publications

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“…Further, while most of the extreme values were present on the second day of life when frequency of intermittent ABGs was reduced, we also noted that several elevated PaCO 2 values were obtained within 20 min of surfactant administration. 18 Importantly, we could not identify any particular complications (tube obstruction, pulmonary hemorrhage, IVH, etc.) that were temporally related to the extreme values.…”

Section: Discussionmentioning

confidence: 92%

“…4 As impaired cerebral autoregulation in premature infants is associated with brain injury, 2,3 hypercapnia may influence the development of severe IVH by vasodilating cerebral resistance arterioles and increasing CBF, and possibly overwhelming the integrity of the germinal matrix vessels causing them to rupture. 17,18 Further, hypercapnia may abolish or impair cerebral autoregulation, causing the cerebral vasculature to be at risk for ischemia or hyperperfusion during fluctuations of blood pressure. [4][5][6] Consistent with our results, most studies examining the relationship between hypercapnia and IVH identified a positive univariate association.…”

Section: Discussionmentioning

confidence: 99%

“…Although it is unclear whether hypercapnia causes IVH or results from circulatory disturbances that follow severe IVH, hypercapnia may influence the development of IVH by causing vasodilation of cerebral resistance arterioles, increasing CBF, and by impairing intact cerebral autoregulation. [4][5][6]17,18 A majority of the published studies reporting an association between hypercapnia and IVH were performed in the pre-surfactant era, where goals for ventilation 19,20 were different than that currently recommended. 21 Before the surfactant era, hypercapnia was likely a proxy for the sickest infants with the most severe respiratory distress syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…We therefore initiated a retrospective study of inborn VLBW infants born during the surfactant and permissive hypercapnia eras with the objective of determining if hypercapnia during the early neonatal period was still associated with IVH. Based on our previous studies, 4,18 we hypothesized that hypercapnia (maximum PaCO 2 ) in VLBW infants during the first 3 days of life is still associated with severe IVH.…”

Section: Introductionmentioning

confidence: 99%

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Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

et al. 2006

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Objective: To examine whether hypercapnia in very low birth weight (VLBW) infants during the first 3 days of life is associated with severe intraventricular hemorrhage (IVH).Study design: Retrospective cohort study of inborn VLBW infants between January 1999 and May 2004 with arterial access during the first 3 days of life. A multiple logistic regression analysis was used where IVH was dichotomized ((grades 0/1/2) ¼ non-severe; (grades 3/4) ¼ severe). Measures of hypercapnia were entered into the model to ascertain their association with severe IVH.Results: In total, 574 VLBW infants met entry criteria. Worst IVH grade was 0 in 400; 1: 54; 2: 42; 3: 47; and 4: 31 infants. The logistic regression model consisted of the following predictors of severe IVH: gestational age, gender, 1 min Apgar score (dichotomized into two groups: >3 vs p3), multifetal gestation, vasopressor use, and maximum PaCO 2 .Conclusion: In addition to traditional risk factors, it appears maximum PaCO 2 is a dose-dependent predictor of severe IVH during the permissive hypercapnia era.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

et al. 2006

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“…Based on our observations that surfactant administration was associated with increases of mean CBFv due primarily to increases in PaCO 2 , 19 we hypothesized that mean CBFv would also increase during and after tracheal suctioning and was primarily related to increases in PaCO 2 .…”

Section: Introductionmentioning

confidence: 99%

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

2007

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Objectives: Examining the effects of tracheal suctioning on cerebral hemodynamics of normotensive ventilated very low birth weight (VLBW) infants with normal cranial ultrasounds; determining the factor(s) influencing changes in mean cerebral blood flow velocity (CBFv) after suctioning.Methods: Seventy-three VLBW infants had continuous monitoring of mean arterial blood pressure (MABP), PaCO 2 , PaO 2 and mean CBFv before, during, and after 202 suctioning sessions during the first week of life. Peak (or nadir) and relative changes of the four variables for 45 min after suctioning were calculated. Multiple linear regression was used to determine the factor(s) influencing changes in mean CBFv after suctioning.Result: Birth weight was 928 ± 244 g; gestational age was 27.0 ± 2.0 weeks. Mean CBFv increased to 31.0 ± 26.4% after suctioning and remained elevated for 25 min. PaCO 2 was highly associated with mean CBFv (P<0.001), whereas MABP and PaO 2 were not. Conclusion:We observed prolonged increases of mean CBFv following suctioning in ventilated VLBW infants that were previously unrecognized. This is concerning since disturbances of CBF may be associated with subsequent brain injury.

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Cerebral oxygenation associated with INSURE versus LISA procedures in surfactant‐deficient newborn piglet RDS model

Rey-Santano

Mielgo

Gomez-Solaetxe

et al. 2019

Pediatric Pulmonology

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Background Nasal continuous‐positive airway pressure (nCPAP) with the INSURE (INtubation‐SURfactant‐Extubation) or LISA (Less‐Invasive Surfactant Administration) procedures are increasingly being chosen as the initial treatment for neonates with surfactant deficiency. Our objective was to compare the effects on cerebral oxygenation of different methods for surfactant administration: INSURE and LISA, using a nasogastric tube (NT) or a LISAcath® catheter, in spontaneously breathing SF‐deficient newborn piglets. Methods Eighteen newborn piglets with SF‐deficient lung injury produced by repetitive bronchoalveolar lavages were randomly assigned to INSURE, LISA‐NT, or LISAcath® groups. We assessed pulmonary (gas exchange, lung mechanics, lung histology) and hemodynamic (mean arterial blood pressure, heart rate) changes, cerebral oxygenation (cTOI) and cerebral fractional tissue extraction (cFTOE), with near‐infrared spectroscopy, carotid blood flow and brain histology. Results SF‐deficient piglets developed respiratory distress (FiO2 = 1, pH <7.2, PaCO2 >70 mmHg, PaO2 <70 mmHg, Cdyn <0.5 mL/cmH2O/kg). Rapid improvements in pulmonary status were observed in all surfactant‐treated groups without hemodynamic alterations. In the INSURE group, a transient decrease in cTOI occurred during and immediately after surfactant administration, while cTOI only decreased during surfactant administration in the LISA‐NT group and did not change significantly in the LISAcath® group. Brain injury scores were low in all surfactant‐treated groups. Conclusion In spontaneously breathing SF‐deficient newborn piglets, short‐lasting decreases in cerebral oxygenation are associated with surfactant administration by the INSURE method or LISA using an NT, while no cerebral oxygenation changes occurred with LISA using a LISAcath®. Notably, none of treatments studied seems to have a negative impact on the neonatal brain.

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Surfactant administration acutely affects cerebral and systemic hemodynamics and gas exchange in very-low-birth-weight infants

Cited by 47 publications

References 29 publications

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Hypercapnia during the first 3 days of life is associated with severe intraventricular hemorrhage in very low birth weight infants

Tracheal suctioning is associated with prolonged disturbances of cerebral hemodynamics in very low birth weight infants

Cerebral oxygenation associated with INSURE versus LISA procedures in surfactant‐deficient newborn piglet RDS model

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