Cerebral Oxygenation during Neonatal Intubation with Nasal High Flow: A Sub-Study of the SHINE Randomized Trial

Abstract

Introduction: Nasal high flow (nHF) improves the likelihood of successful neonatal intubation on the first attempt without physiological instability. The effect of nHF on cerebral oxygenation is unknown. The aim of this study was to compare cerebral oxygenation during endotracheal intubation in neonates receiving nHF and those receiving standard care. Methods: A sub-study of a multicentre randomized trial of nHF during neonatal endotracheal intubation. A subset of infants had near-infrared spectroscopy (NIRS) monitoring. Eligible infants were randomly assigned to nHF or standard care during the first intubation attempt. NIRS sensors provided continuous regional cerebral oxygen saturation (rScO₂) monitoring. The procedure was video recorded, and peripheral oxygen saturation and rScO₂ data were extracted at 2-second intervals. The primary outcome was the average difference in rScO₂ from baseline during the first intubation attempt. Secondary outcomes included average rScO₂ and rate of change of rScO₂. Results: Nineteen intubations were analyzed (11 nHF; 8 standard care). Median (interquartile range [IQR]) postmenstrual age was 27 (26.5–29) weeks, and weight was 828 (716–1,135) g. Median change in rScO₂ from baseline was −1.5% (−5.3 to 0.0) in the nHF group and −9.4% (−19.6 to −4.5) in the standard care group. rScO₂ fell more slowly in infants managed with nHF compared with standard care: median (IQR) rScO₂ change −0.08 (−0.13 to 0.00) % per second and −0.36 (−0.66 to −0.22) % per second, respectively. Conclusions: In this small sub-study, regional cerebral oxygen saturation was more stable in neonates who received nHF during intubation compared with standard care.