Original Article
Effects of Endotracheal Intubation and Surfactant on a 3-Channel Neonatal Electroencephalogram

https://doi.org/10.1016/j.jpeds.2012.02.014Get rights and content

Objective

To evaluate the effects of surfactant administration on the neonatal brain using 3-channel neonatal electroencephalography (EEG).

Study design

A prospective cohort of 30 infants had scalp electrodes placed to record brain waves using 3-channel EEG (Fp1-O1, C3-C4, and Fp2-O2). Sixty-second EEG epochs were collected from a 10-minute medication-free baseline, during premedication for endotracheal intubation, at surfactant administration, and at 10, 20, and 30 minutes after surfactant administration for amplitude comparisons. Oxygen saturation and heart rate were monitored continuously. Blood pressure and transcutaneous carbon dioxide were recorded every 5 minutes.

Results

Eighteen of 29 infants (62%) exhibited brain wave suppression on EEG after surfactant administration (P ≤ .008). Four of those 18 infants did not receive premedication. Nine infants exhibited evidence of EEG suppression during endotracheal intubation, all of whom received premedication before intubation. Five infants had EEG suppression during endotracheal suctioning. Oxygen saturation, heart rate, and blood pressure were not independent predictors of brain wave suppression.

Conclusion

Eighteen of 29 intubated infants (62%) had evidence of brain wave suppression on raw EEG after surfactant administration. Nine patients had evidence of brief EEG suppression with endotracheal intubation alone, a finding not previously reported in neonates. Intubation and surfactant administration have the potential to alter cerebral function in neonates.

Section snippets

Methods

A prospective cohort of 30 infants (24 preterm and 6 full term) who were admitted to the University of California San Diego's Infant Special Care Center and who underwent endotracheal intubation and/or surfactant administration were studied using 3-channel EEG between December 2009 and December 2010. The University's Institutional Review Board approved the study, and previous informed consent was obtained from a parent of each enrolled infant.

Any newborn in the Infant Special Care Center who

Results

The study cohort included 30 patients admitted to the University of California San Diego's Infant Special Care Center between December 2009 and December 2010 (Table). One term infant whose records were not retrievable from the digital recording storage media was excluded from the analysis; thus, 29 infants were analyzed. Birth weight ranged from 590 to 4425 g (mean, 2085 ± 986 g), and gestational age at birth ranged from 25.5 to 41.6 weeks (mean, 33 ± 4.3 weeks). EEG recordings were collected

Discussion

This prospective study found significant brain wave suppression on multichannel EEG after surfactant administration in the majority of infants studied. Our finding of amplitude suppression using multichannel EEG after surfactant administration provides a more detailed look at brain wave suppression than previous studies, which used only single-channel aEEG.4, 5, 6, 7 Brain wave suppression was not correlated with SpO2, BP, heart rate, or TcCO2. Interestingly, 14 of the 18 infants demonstrating

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  • Cited by (0)

    The authors declare no conflicts of interest.

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