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.

中文翻译：

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新生儿经鼻高流量插管期间的脑氧合：SHINE 随机试验的子研究。

简介 经鼻高流量 (nHF) 提高了新生儿首次插管成功的可能性，且没有生理不稳定。nHF 对脑氧合的影响尚不清楚。本研究的目的是比较接受 nHF 的新生儿和接受标准护理的新生儿气管插管期间的脑氧合。方法 对新生儿气管插管期间 nHF 进行多中心随机试验的子研究。对一部分婴儿进行近红外光谱 (NIRS) 监测。符合条件的婴儿在第一次插管尝试期间被随机分配至 nHF 或标准护理组。NIRS 传感器提供连续的局部脑氧饱和度 (rScO2) 监测。该过程被视频记录，并以 2 秒的间隔提取外周血氧饱和度和 rScO2 数据。主要结果是第一次插管尝试期间 rScO2 与基线的平均差异。次要结果包括平均 rScO2 和 rScO2 变化率。结果 分析了 19 次插管（11 次 nHF；8 次标准护理）。中位（四分位距 [IQR]）月经后年龄为 27 (26.5-29) 周，体重为 828 (716-1,135) g。nHF 组中 rScO2 相对于基线的中位变化为 -1.5%（-5.3 至 0.0），标准护理组中为 -9.4%（-19.6 至 -4.5）。与标准护理相比，nHF 治疗婴儿的 rScO2 下降速度更慢：中位 (IQR) rScO2 变化分别为每秒 -0.08（-0.13 至 0.00）% 和每秒 -0.36（-0.66 至 -0.22）%。结论 在这项小型子研究中，与标准护理相比，插管期间接受 nHF 的新生儿的局部脑氧饱和度更稳定。