Comparison of effects of endotracheal suctioning and surfactant administration on hemodynamics and oxygenation in premature infants - A near infraredspectroscopy study

Background: Aim of this study was to assess whether the decrease in heart r ate and oxygen saturation occurring acutely after bolus administration of s urfactant is different from the effect of endotracheal suctioning and wheth er there are effects on cerebral haemodynamics and oxygenation. Methods: Twelve premature infants, birth weight 720-1560 g (Median 9359), g estational age 25-30 weeks (Median 28 weeks), were investigated during surf actant administration (Curosurf((R))) as a single bolus and a preceding end otracheal suctioning procedure. Using near infrared spectroscopy changes in cerebral blood volume and cerebral oxygenation index were assessed. Heart rate, arterial oxygen saturation, PCO2, and arterial blood pressure were re gistered continuously. Data were compared at 30, 60 and 120 seconds after t he beginning of suctioning and surfactant administration. Results: Endotracheal suctioning and surfactant administration induced a si milar decrease in heart rate (-29/min, SD 25, p < 0.01 and -30/min, SD 23, p < 0.001) during the first 30 seconds and in oxygen saturation at the 30 s econds datapoint (-3 %, SD 2, p < 0.01 and -3%, SD 6, p < 0.05). The decrea se in oxygen saturation persisted at 60 seconds after the start of suctioni ng (-4%, SD 5, p < 0.05). in contrast, oxygen saturation was no longer diff erent from baseline levels 60 seconds after surfactant administration (+ 1 %, SD 6, p = 0.5). After suctioning, cerebral oxygenation index had decreas ed significantly from baseline levels at 30, 60, and 120 seconds. In contra st, after surfactant administration, no significant difference from baselin e was noted at 30 and 60 seconds and a significant increase occurred at 720 seconds. Mean arterial blood pressure, PCO2, and cerebral blood volume did not change significantly during endotracheal suctioning and during surfact ant administration. Conclusions: Acute decreases in heart rate and oxygen saturation during bol us administration of surfactant are equal to effects occurring during endot racheal suctioning. However, the decrease in oxygen saturation is shorter a nd more importantly, no decrease in cerebral oxygenation occurs.