Effects of different surfactant administrations on cerebral autoregulation in preterm infants with respiratory distress syndrome

Abstract

To treat respiratory distress syndrome, surfactant is currently delivered via less invasive surfactant administration (LISA) or INtubation SURfactant Extubation (INSURE). The aim of this study was to compare the effect of the two delivery methods of surfactant on cerebral autoregulation. Near infrared spectroscopy monitoring was carried out to detect cerebral oxygen saturation (ScO₂), and the mean arterial blood pressure (MABP) was simultaneously recorded. Of 44 preterm infants included, the surfactant was administrated to 22 via LISA and 22 via INSURE. The clinical characteristics, treatments and outcomes of the infants showed no significant differences between the two groups. The correlation coefficient of ScO₂ and MABP (r_ScO2-MABP) 5 min before administration was similar in the two groups. During surfactant administration, r_ScO2-MABP increased in both groups (0.44±0.10 to 0.54±0.12 in LISA, 0.45±0.11 to 0.69±0.09 in INSURE). In the first and second 5 min after instillation, r_ScO2-MABP was not significantly different from baseline in the LISA group, but increased in the first 5 min after instillation (0.59±0.13, P=0.000 compared with the baseline in the same group) and recovered in the second 5 min after instillation (0.48±0.10, P=0.321) in the INSURE group. There were significant differences in the change rates of r_ScO2-MABP between the two groups during and after surfactant administration. Our results suggest that cerebral autoregulation may be affected transiently by surfactant administration. The effect duration of LISA is shorter than that of INSURE (<5 min in LISA vs. 5–10 min in INSURE).

Keywords

preterm infant / respiratory distress syndrome / surfactant / cerebral autoregulation / pulmonary surfactant

References

[1] BlennowM, BohlinK. Surfactant and noninvasive ventilation. Neonatology, 2015, 107(4): 330-336 PMID: 26044100

[2] Klebermass-SchrehofK, WaldM, SchwindtJ, et al. . Less invasive surfactant administration in extremely preterm infants: impact on mortality and morbidity. Neonatology, 2013, 103(4): 252-258 PMID: 23446061

[3] BaoY, ZhangG, WuM, et al. . A pilot study of less invasive surfactant administration in very preterm infants in a Chinese tertiary center. BMC Pediatr, 2015, 15(1): 1-6

[4] HertingE. Less invasive surfactant administration (LISA) -ways to deliver surfactant in spontaneously breathing infants. Early Hum Dev, 2013, 89(11): 875-880 PMID: 24075206

[5] GöpelW, KribsA, ZieglerA, et al. . Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet, 2011, 378(9803): 1627-1634 PMID: 21963186

[6] KanmazHG, ErdeveO, CanpolatFE, et al. . Surfactant administration via thin catheter during spontaneous breathing: randomized controlled trial. Pediatrics, 2013, 131(2): e502-e509 PMID: 23359581

[7] VutskitsL. Cerebral blood flow in the neonate. Paediatr Anaesth, 2014, 24(1): 22-29 PMID: 24238074

[8] SoulJS, HammerPE, TsujiM, et al. . Fluctuating pressure-passivity is common in the cerebral circulation of sick premature infants. Pediatr Res, 2007, 61(4): 467-473 PMID: 17515873

[9] BackSA. Cerebral white and gray matter injury in newborns: New insights into pathophysiology and management. Clin Perinatol, 2014, 41(1): 1-24 PMID: 24524444 PMCID: 3947650

[10] VolpeJJ. Hypoxic-ischemic encephalopathy: biochemical and physiological aspects. Neurology of the newborn, 2008, Philadelphia, Saunders Elsevier, 247-324

[11] LemmersPM, ToetM, van SchelvenLJ, et al. . Cerebral oxygenation and cerebral oxygen extraction in the preterm infant: the impact of respiratory distress syndrome. Exp Brain Res, 2006, 173(3): 458-467 PMID: 16506004

[12] AlbertineKH. Brain injury in chronically ventilated preterm neonates: collateral damage related to ventilation strategy. Clin Perinatol, 2012, 39(3): 727-740 PMID: 22954278 PMCID: 3437037

[13] PromjunyakulN, LahnaD, KayeJA, et al. . Characterizing the white matter hyperintensity penumbra with cerebral blood flow measures. Neuroimage Clin, 2015, 8: 224-229 PMID: 26106546 PMCID: 4473817

[14] CaicedoA, AlderliestenT, NaulaersG, et al. . A new framework for the assessment of cerebral hemodynamics regulation in neonates using NIRS. Adv Exp Med Biol, 2016, 876: 501-509 PMID: 26782251

[15] MunroMJ, WalkerAM, BarfieldCP. Hypotensive extremely low birth weight infants have reduced cerebral blood flow. Pediatrics, 2004, 114(6): 1591-1596 PMID: 15574619

[16] GreisenG. Autoregulation of cerebral blood flow in newborn babies. Early Hum Dev, 2005, 81(5): 423-428 PMID: 15935919

[17] GöpelW, KribsA, HärtelC, et al. . Less invasive surfactant administration is associated with improved pulmonary outcomes in spontaneously breathing preterm infants. Acta Paediatr, 2015, 104(3): 241-246 PMID: 25474712

[18] VesoulisZA, LiaoSM, TrivediSB, et al. . A novel method for assessing cerebral autoregulation in preterm infants using transfer function analysis. Pediatr Res, 2016, 79(3): 453-459 PMID: 26571222

[19] StammwitzA, vonSK, BucherHU, et al. . Can the assessment of spontaneous oscillations by near infrared spectrophotometry predict neurological outcome of preterm infants. Adv Exp Med Biol, 2016, 876: 521-531 PMID: 26782253