Related Experiment Video
Updated: Jun 6, 2026
07:36
Modeling Encephalopathy of Prematurity Using Prenatal Hypoxia-ischemia with Intra-amniotic Lipopolysaccharide in Rats
Published on: November 20, 2015
Risk factors for INSURE failure in preterm infants
1Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Florence, Italy.
Minerva Pediatrica
|November 25, 2010
Summary
The INSURE method helps preterm infants with respiratory distress syndrome (RDS). Specific factors predict INSURE failure, but repeated treatments may improve outcomes and reduce mechanical ventilation needs.
Area of Science:
- Neonatal medicine
- Pediatric respiratory care
- Critical care medicine
Background:
- Respiratory distress syndrome (RDS) is a common condition in preterm infants.
- The Intubation-surfactant-extubation (INSURE) method is a strategy to manage RDS, aiming to reduce mechanical ventilation (MV).
- INSURE is not always successful, necessitating identification of failure predictors and alternative strategies.
Purpose of the Study:
- To identify independent risk factors for INSURE failure in preterm infants with gestational age <30 weeks.
- To evaluate the effectiveness of repeated INSURE procedures on respiratory outcomes.
- To explore the potential of a multiple INSURE strategy to improve treatment efficacy and reduce MV dependence.
Main Methods:
- Retrospective analysis of preterm infants (<30 weeks gestational age) with RDS undergoing INSURE.
- Statistical analysis to identify independent risk factors for INSURE failure based on birth weight and first blood gas parameters (pO2/FiO2, a/ApO2).
- Comparison of respiratory outcomes between infants receiving single versus multiple INSURE procedures.
Main Results:
- Birth weight <750 g, pO2/FiO2 <218, and a/ApO2 < 0.44 at the first blood gas analysis were identified as independent risk factors for INSURE failure.
- Respiratory outcomes were similar in infants treated with single or multiple INSURE procedures.
- Repeated INSURE treatment did not worsen respiratory outcomes.
Conclusions:
- Preterm infants with specific low birth weight and early blood gas derangements are at higher risk of INSURE failure.
- The INSURE procedure can be safely repeated.
- A multiple INSURE strategy may offer a viable approach to decrease INSURE failure rates and enhance its effectiveness in preventing mechanical ventilation.
Related Concept Videos
01:07Teratogenicity
The ability of a drug to produce structural deformations and functional abnormalities in the developing embryo or the fetus is called teratogenicity, and the drug producing this effect is known as a teratogen. Teratogenic effects include stillbirth, miscarriage, intrauterine growth restriction, and neurocognitive delay. A teratogen may affect the embryo at different stages of development, which is important in determining the type and extent of the damage. During blastocyst formation, the early...
01:28Development of the Oral Microbiota
The establishment of the oral microbiome begins before birth, challenging the long-held belief that the fetal oral cavity is sterile. The presence of oral microbes such as Streptococcus and Fusobacterium in amniotic fluid suggests that microbial exposure may occur in utero, potentially through translocation from the maternal oral or gastrointestinal tract. This early colonization primes the neonatal immune system and sets the stage for subsequent microbial succession. Maternal health,...
01:21Acute Respiratory Failure-II
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:20Pathophysiology of Diabetes
Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility, suggesting a...
01:21Acute Respiratory Failure-I
Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:26Factors Affecting the Risk of Infection
The hosts' susceptibility to infection depends on several factors. The integrity of the skin and mucous membranes helps protect the body against microbial attacks. When the skin is altered, the chance of infection, limb loss, and even death increases.
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin create...