Objectives Compare the effects of clinically indicated tracheal suctioning (open vs. closed) procedures on cerebral hemodynamics of normotensive, non-brain-injured, and ventilated very low birth weight (VLBW) infants during the first week of life.

Methods Seventy-three VLBW infants had continuous monitoring of blood pressure, PCO2, and cerebral blood flow velocity (CBFv) before, during, and after 202 open (requiring ventilator disconnection) suctioning sessions during the first week of life. Forty-one VLBW infants had similar physiological monitoring before, during, and after 167 closed (in-line) suctioning sessions.

Results Birth weight was 928±244 g and gestational age was 27.0±2.0 weeks for the infants receiving open suctioning. Birth weight and gestational age was 780±195 g and 26.1±1.5 weeks, respectively, for the infants receiving closed suctioning. Mean CBFv increased 31.0±26.4% after open tracheal suctioning and remained elevated for 25 minutes; changes in mean CBFv were highly associated with changes in PCO2 (P<0.001). In contrast, during closed suctioning, mean CBFv (as well as PCO2) did not appreciably change. Mean CBFv following open and closed suctioning was statistically significantly different (P<0.0001).

Conclusion Using continuous monitoring, we observed prolonged increases of mean CBFv following open tracheal suctioning in relatively low-risk ventilated VLBW infants that were previously unrecognized. This is concerning since abrupt increases in CBF in premature infants and neonatal animals have been associated with brain injury. Since cerebral hemodynamics did not change following closed suctioning, this method of suctioning may be preferable for ventilated VLBW infants during the first week of life who are most vulnerable to brain injury.