BACKGROUND: In preterm infants with respiratory distress syndrome (RDS) nasal 
continuous positive airway pressure (nCPAP) with the "InSurE" procedure 
(intubation, surfactant, extubation) is increasingly used. However, its effect 
on cerebral oxygenation and brain function is not known.
OBJECTIVE: To evaluate the effects of the "InSurE" procedure in infants with RDS 
on regional cerebral oxygen saturation (rScO(2)) and relative cerebral 
fractional tissue oxygen extraction (cFTOE) using near infrared spectroscopy and 
on electrical brain activity using amplitude-integrated electroencephalography 
(aEEG).
METHODS: Sixteen infants with RDS, treated with the "InSurE" procedure, and 16 
matched controls with nCPAP, were monitored for mean arterial blood pressure 
(MABP), arterial oxygen saturation (SaO(2)), rScO(2), cFTOE and aEEG. Ten-minute 
periods were selected and averaged at 120 and 20 minutes before, during the 
procedure and at 30 minutes, 1, 2, 6, 12 and 24 h after the start of the 
"InSurE" procedure. aEEG was analysed by quantitative and qualitative (Burdjalov 
score) methods.
RESULTS: MABP was not different between groups on all time points. rScO(2) and 
cFTOE were comparable between groups, but there was a trend towards lower 
rScO(2) and higher cFTOE 30 minutes after opioid administration in the "InSurE" 
infants compared with controls (62% (SD 11) vs 68% (SD 10) and 0.30 (SD 0.10 ) 
vs 0.28 (SD 0.11), respectively). aEEG amplitudes and Burdjalov scores were 
significantly lower in "InSurE" infants from 30 minutes after opioid 
administration up to 24 h after the start of the procedure (p<0.05).
CONCLUSION: In the present study, the "InSurE" procedure did not induce 
perturbation of cerebral oxygen delivery and extraction, whereas electrical 
brain activity decreased for a prolonged period of time.