Surfactant administration and cerebral oxygenation and perfusion in preterm neonates - A systematic review of literature.

Abstract

Background: Surfactant replacement is standard for preterm neonates with respiratory distress syndrome, improving survival and outcomes. Less invasive surfactant administration (LISA) and intubation-surfactant-extubation (INSURE) are preferred methods for surfactant replacement in spontaneously breathing preterm neonates. Despite the undeniable benefits of surfactant implementation in neonatal care, surfactant administration can affect vital parameters and cerebral oxygenation and perfusion, assessed by near-infrared spectroscopy (NIRS).

Objective: This review systematically examined the literature on surfactant administration in preterm neonates and its impact on NIRS-measured cerebral oxygenation.

Methods: A systematic search of PubMed, Embase, CINAHL, Clinical Trials, and Ovid Medline was conducted using following terms: newborn, infant, neonate, preterm, premature, prematurity, surfactant, LISA, less-invasive surfactant administration, INSURE, near-infrared-spectroscopy, NIRS, oximetry, spectroscopy, cerebral oxygenation, cerebral tissue oxygen saturation (crSO₂), crSO₂, cerebral perfusion. Only studies in human preterm neonates were included.

Results: Sixteen studies were identified that described cerebral oxygenation measured by NIRS in the context of surfactant administration demonstrating a decrease in crSO₂ during surfactant administration, followed by a subsequent increase. Three studies specifically described the course of crSO₂ in neonates while receiving LISA, whereby in two of these LISA was compared to INSURE describing differences in crSO₂ behaviour. Two additional studies described surfactant administration using the INSURE procedure and the influence on cerebral oxygenation. Ten studies investigated surfactant administration in intubated neonates receiving mechanical ventilation. One study described crSO₂ in neonates receiving aerosolised surfactant.

Conclusion: This systematic review indicates that surfactant administration is associated with a transient decrease in crSO₂ followed by a return to baseline levels, whereby differences between the LISA and INSURE methods were observed.