Cerebral Oxygen Saturation During Less‐Invasive Surfactant Administration Using a High‐Pressure CPAP Respiratory Support Delivery Room Protocol—A Cohort Study

ABSTRACT Aim To describe changes in peripheral oxygen saturation (SpO 2 ) and regional cerebral oxygenation (rcSO 2 ) during less invasive surfactant administration (LISA) in a high‐level continuous positive airway pressure (CPAP) respiratory support delivery room protocol in very low birth weight infants (VLBW). Methods This is a secondary analysis of data from the randomized‐controlled Extrauterine Placental Transfusion in Resuscitation of VLBW infants (EXPLAIN) trial. In total, 38 patients were included. The pressure and changes in heart rate, SpO 2 and rcSO 2 were assessed 10 min before until 10 min after the LISA procedure. Basic outcome data for the patient collective were collected. Results Mean gestational age was 27 + 6 weeks (±15 days), and mean birth weight was 995.8 g (±298.8). All infants were eligible for LISA. During LISA, heart rate, SpO 2 and rcSO 2 decreased significantly (mean change 32.4 (± 27.5) bpm, −14.5 (± 10.7) % and −11.9 (± 9.1) %, respectively; all p < 0.001). Moreover, two infants developed a pneumothorax and three infants required endotracheal intubation within 72 h after birth. Conclusions With the approach of a high‐level CPAP setting, we observed transient decreases in heart rate and oxygenation levels during LISA. The magnitude of these decreases was within the expected or potentially favourable range compared with prior studies. Trial Registration ClinicalTrials.gov identifier:NCT03916159