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Gary H. Burgess, MD; William Oh, MD; Benjamin S. Brann IV, MD; Ann-Mari Brubakk, MD; Barbara S. Stonestreet, MD

Arch Pediatr Adolesc Med. 2001;155:723-727.

Objective  To examine the effect of phenobarbital administration on anterior cerebral artery blood flow velocity before and after endotracheal suctioning in premature neonates.

Design  Transcutaneous PO₂ (TcPO₂), heart rate, mean arterial blood pressure (MABP), and Doppler velocimeter blood flow of the left anterior cerebral artery were measured before and immediately after 3 consecutive endotracheal suctioning procedures in premature neonates. Intravenous phenobarbital (20 mg/kg) was administered immediately after the first procedure.

Setting  Neonatal intensive care unit.

Patients  Nine neonates with a mean birth weight of 807 g (range, 620-1060 g) and a mean gestational age of 27 weeks (range, 25-30 weeks) were studied at age 8 to 12 hours.

Results  Transcutaneous PO₂ decreased in response to endotracheal suctioning at each of the suctioning procedures before and after phenobarbital was given (P<.001). Changes in heart rate were not observed. There were increases in MABP and area under the velocity curve (AUVC) per minute in response to endotracheal suctioning before but not after phenobarbital administration (P= .046). Use of phenobarbital lowered the overall peak systolic blood flow velocity in response to endotracheal suctioning (P = .02, analysis of variance, interactions for the effect of phenobarbital therapy on the response to suctioning). Changes in end-diastolic blood flow velocity were not observed. There were decreases in the differences before and after endotracheal suctioning for MABP at 2 and 4 hours and for AUVC and peak systolic blood flow velocity 4 hours after phenobarbital was given (P = .04).

Conclusions  In very low-birth-weight neonates, endotracheal suctioning is associated with decreases in TcPO₂ and increases in MABP and AUVC. Treatment with phenobarbital attenuates the increases in MABP and AUVC but not the decreases in TcPO₂ after endotracheal suctioning.

From the Department of Pediatrics, Brown University School of Medicine, Women and Infants Hospital of Rhode Island, Providence.

Corresponding author and reprints: Barbara S. Stonestreet, MD, Department of Pediatrics, Brown University School of Medicine, Women and Infants Hospital of Rhode Island, 101 Dudley St, Providence, RI 02905-240 (e-mail: bstonest{at}wihri.org).