Effects of endotracheal intubation and surfactant on a 3-channel neonatal electroencephalogram

Abstract

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.

Figure 1.

EEG amplitude for channel C3-C4 in microvolts. Baseline amplitude is medication/surfactant free recording during first 10 minutes of study, followed by surfactant administration 10, 20, and 30 minutes post-surfactant administration amplitudes. * Indicates significant level of P ≤ .008. Outliers not shown on box-plot. SA, surfactant administration.

Figure 2.

Amplitude suppression and background pattern changes on EEG Channels: Fp1-O1, C3-C4, Fp2-O2, EKG following laryngoscope blade insertion for endotracheal intubation in a 31 week female (1855 g) premedicated with atropine, narcotic, and paralytic prior to endotracheal intubation for respiratory distress syndrome. Artifact noted on EEG following removal of orogastric tube and just before laryngoscope blade insertion. Gain: 7 mm, Low Frequency Filter of 1 Hz, High Frequency Filter of 20 Hz. Recording speed 30 mm/ sec. OG, orogastric tube.