Change of Cerebral Oxygenation during Surfactant Treatment in Preterm Infants: "LISA" versus "InSurE" Procedures.

Objectives  The aim of the study was to compare the effects on cerebral oxygenation in preterm infants of two different procedures for surfactant administration: the LISA (low-invasive method of surfactant administration) and the InSurE (Intubation, SURfactant administration, Extubation). Study Design  Twenty premature infants with respiratory distress syndrome were assigned to receive surfactant either by "LISA" ( n  = 10) or "InSurE" ( n  = 10) procedure. Patients were continuously studied by near-infrared spectroscopy (NIRS) for the measurement of cerebral regional oxygenation (rSO2 C) and calculation of cerebral fractional oxygen extraction rate (cFTOE), and NIRS data were recorded 30 minutes before ( T 0 ) surfactant administration, during the procedure ( T proc ), and 30 ( T 1 ), 60 ( T 2 T 2 ), and 120 minutes ( T 3 ) afterward. Cerebral blood flow velocity (CBFV) was studied in the anterior cerebral artery at T 0 , T 1 , and T 3 . Results  SpO2 significantly decreased at T proc in comparison with T 0 , T 1 , T 2 , and T 3 and the decrease was higher in the LISA than in the InSurE group. rSO2 C was lower at t proc and T 3 in the LISA than in the InSurE group. cFTOE was higher at t proc , t 2 , and t 3 in the LISA group than in the InSurE group. CBFV did not change during the study periods in both groups. Conclusions  The LISA and InSurE procedures transiently decreased rSO2 C in our population, and the decrease was higher in the LISA group. Consistently, there was a contemporary increase in cFTOE that was higher in the LISA than in the InSurE group, suggesting that it represents a compensatory mechanism.