The Effect of the "InSurE" procedure on Cerebral Oxygenation and Electrical Brain Activity of the Preterm Infant

Esther van de Berg ¹, Petra M A Lemmers ^1*, Mona C Toet ¹, John Klaessens ² and Frank van Bel ¹

¹ Department of Neonatology,Wilhelmina Children's Hospital, Utrecht, Netherlands
² Department of Medical Technology and Clinical Physics,Wilhelmina Children's Hospital Utrecht, Netherlands

^* To whom correspondence should be addressed. E-mail: plemmers{at}umcutrecht.nl.

Accepted 30 July 2009

Abstract

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 effects of the "InSurE" procedure in infants with RDS on cerebral oxygenation (rScO2) and oxygen extraction (cFTOE) using near infrared spectroscopy (NIRS) and on electrical brain activity using amplitude integrated EEG (aEEG).

Methods: Sixteen infants with RDS, treated with the "InSurE" procedure, and sixteen matched controls with nCPAP, were monitored for blood pressure (MABP), arterial saturation (SaO2), rScO2, 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 hours after start of the InSurE procedure. aEEG was analysed by quantitative and qualitative (Burdjalov score) methods.

Results: MABP was not different between groups on alle time-points. rScO2 and cFTOE were comparable between groups, but there was a trend towards lower rScO2 and higher cFTOE 30 minutes after opioid administration in the "InSurE" infants compared with controls (62±11% vs 68±10% and 0.30±0.10 vs 0.28±0.11 respectively). aEEG-amplitudes and Burdjalov scores were significantly lower in "InSurE" infants from 30 minutes after opioid administration up to 24 hours after start of the procedure (p<0.05).

Conclusion: In the present study, we show that the "InSurE" procedure did not induce perturbation of cerebral oxygen delivery and extraction, while electrical brain activity decreased for a prolonged period of time.