Arch Dis Child Fetal Neonatal Ed 95:F53-F58 doi:10.1136/adc.2008.156414
  • Original article

Effect of the “InSurE” procedure on cerebral oxygenation and electrical brain activity of the preterm infant

  1. E van den Berg1,
  2. P M A Lemmers1,
  3. M C Toet1,
  4. J H G Klaessens2,
  5. F van Bel1,1
  1. 1
    Department of Neonatology, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
  2. 2
    Department of Medical Technology and Clinical Physics, University Medical Center Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
  1. Correspondence to Dr P M A Lemmers, Department of Neonatology, Room KE.04.123.1, Wilhelmina Children’s Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, The Netherlands; p.lemmers{at}
  • Accepted 30 July 2009
  • Published Online First 13 August 2009


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 the effects of the “InSurE” procedure in infants with RDS on regional cerebral oxygen saturation (rScO2) and relative cerebral fractional tissue oxygen extraction (cFTOE) using near infrared spectroscopy and on electrical brain activity using amplitude-integrated electroencephalography (aEEG).

Methods: Sixteen infants with RDS, treated with the “InSurE” procedure, and 16 matched controls with nCPAP, were monitored for mean arterial blood pressure (MABP), arterial oxygen 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 h after the start of the “InSurE” procedure. aEEG was analysed by quantitative and qualitative (Burdjalov score) methods.

Results: MABP was not different between groups on all 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% (SD 11) vs 68% (SD 10) and 0.30 (SD 0.10 ) vs 0.28 (SD 0.11), respectively). aEEG amplitudes and Burdjalov scores were significantly lower in “InSurE” infants from 30 minutes after opioid administration up to 24 h after the start of the procedure (p<0.05).

Conclusion: In the present study, the “InSurE” procedure did not induce perturbation of cerebral oxygen delivery and extraction, whereas electrical brain activity decreased for a prolonged period of time.


  • Competing interests None.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

  • Ethics approval The study was approved by the Medical Ethical Committee of the University Medical Center Utrecht.

  • Patient consent Obtained.

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