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

Acta Paediatr. 2020 Feb;109(2):291-299. doi: 10.1111/apa.14939. Epub 2019 Sep 5.


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.

Keywords: cerebral oxygenation saturation; less invasive surfactant administration; near-infrared spectroscopy; preterm infants.

Publication types

  • Observational Study

MeSH terms

  • Continuous Positive Airway Pressure
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Intubation, Intratracheal
  • Pulmonary Surfactants* / therapeutic use
  • Respiratory Distress Syndrome, Newborn* / drug therapy
  • Surface-Active Agents / therapeutic use


  • Pulmonary Surfactants
  • Surface-Active Agents