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

Aim: To 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. Methods: In 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. Results: We 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). Conclusion: Our observational data indicate that rcSO₂ values of infants in the LISA group were similar to the CPAP group.