The effect of less invasive surfactant administration on cerebral oxygenation in preterm infants

Abstract

AimTo determine the regional cerebral tissue oxygenation saturation (rcSO2) in a group of infants requiring less invasive surfactant administration (LISA) as compared to infants with continuous positive airway pressure (CPAP) only.MethodsIn preterm infants with a gestational age 26 0/7‐31 6/7 weeks, we conducted an observational study using near‐infrared spectroscopy (NIRS) in the first 120 hours of life.ResultsWe analysed the data of 22 infants who never received surfactant (CPAP), 22 infants had LISA and CPAP (LISA) and 6 infants received surfactant via endotracheal tube (ETT). Four infants had both surfactant application modes including six LISA applications. In total, there were 32 successful LISA applications but 44 attempts; 13/44 (30%) of LISA attempts resulted in a 20% decrease of rcSO2. During the first 120 hours of life, rcSO2 values of CPAP were similar to those of infants in the LISA group, that is median rcSO2 values 90% vs 85%, respectively (P = .126). Episodes with rcSO2 values <65% were 0.4% in the CPAP group as compared to 4.8% in the LISA group (P < .001).ConclusionOur observational data indicate that rcSO2 values of infants in the LISA group were similar to the CPAP group.

Early Skin-to-Skin Contact Does Not Affect Cerebral Tissue Oxygenation in Preterm Infants <32 Weeks of Gestation

“…We found no remarkable differences between SSC and handling care. Notably, our study cohort achieved a high rate of previously published target levels 55–85% during SSC [ 19 , 20 , 21 ]. These results support and reveal that skin-to-skin contact does not increase cerebral hemodynamic instability in the first 120 h of life, which is in contrast to previous observations by Bohnhorst et al [ 11 ].…”

Noninvasive Ventilation and Exogenous Surfactant in Times of Ever Decreasing Gestational Age: How Do We Make the Most of These Tools?

“…54,[56][57][58][59][60] Potential advantages of LISA/MIST compared with standard surfactant via ETTwhen performed by experienced proceduralists-comprise the avoidance of positive pressure ventilation while providing similar effectiveness of surfactant deposition as compared with ETT, risk reduction of intubation trauma by using small diameter catheters for surfactant administration, maintenance of physiological larynx and glottis function, and support of physiological adaptation after birth, including lung recruitment, circulation, and regional tissue oxygenation. [61][62][63][64][65][66][67][68][69][70] Of note, in units practicing LISA and MIST, the procedure is considered as one part of a whole bundle of "less intensive or less invasive support measures," including delayed cord clamping, avoidance of hypothermia and discomfort, and the acceptance of positive endexpiratory pressure levels of 8 cm H 2 0 or greater, as well as the early initiation of caffeine. [71][72][73]…”

Association of Administration of Surfactant Using Less Invasive Methods With Outcomes in Extremely Preterm Infants Less Than 27 Weeks of Gestation

“…Fourth, surfactant administration is just one part of LISA, which comprises other components that may have differential effects and are difficult to account for in observational studies. [19][20][21][22] For example, several GNN centers use caffeine in the delivery room and introduce colostrum feeding in the first hour of life, given the potential antioxidative effect. 9,23…”