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Published on: November 20, 2015
Effect of multiple INSURE procedures in extremely preterm infants
Carlo Dani1, Iuri Corsini, Giovanna Bertini
1Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Viale Morgagni 85, Florence, Italy. cdani@unifi.it
Insights
Single and multiple intubation-surfactant-extubation (INSURE) procedures showed similar outcomes for extremely preterm infants regarding the need for mechanical ventilation and bronchopulmonary dysplasia. Further research is needed to confirm if multiple INSURE enhances success rates.
Area of Science:
- Neonatalogy
- Pediatric Pulmonology
- Perinatal Medicine
Background:
- Respiratory Distress Syndrome (RDS) is a common condition in extremely preterm infants.
- The intubation-surfactant-extubation (INSURE) procedure is a common treatment for RDS.
- The optimal number of INSURE procedures for managing RDS in preterm infants is not well-established.
Purpose of the Study:
- To compare the effects of single versus multiple INSURE procedures on the need for mechanical ventilation (MV) and the occurrence of bronchopulmonary dysplasia (BPD).
- To evaluate respiratory outcomes in extremely preterm infants treated with different INSURE strategies.
Main Methods:
- A cohort of infants with gestational age <30 weeks and diagnosed with RDS was studied.
- Infants received either single or multiple INSURE procedures, defined by oxygen requirements without MV.
- Respiratory outcomes including need for MV and incidence of BPD were assessed.
Main Results:
- Seventy-five infants were analyzed; 53 received single INSURE and 22 received multiple INSURE.
- Rates of MV need (15% vs. 23%) and BPD occurrence (9% vs. 9%) were similar between single and multiple INSURE groups.
- Infants in the multiple INSURE group were more immature and had more severe RDS at baseline.
Conclusions:
- Both single and multiple INSURE procedures resulted in comparable respiratory outcomes in extremely preterm infants.
- Further studies are required to determine if a multiple INSURE strategy improves success rates in preventing MV and BPD.
Objectives:
Our aim was to evaluate whether single and multiple intubation-surfactant-extubation (INSURE) procedures have similar effects on the need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia (BPD) in extremely preterm infants.
Methods:
We studied infants of <30 weeks of gestation with respiratory distress syndrome (RDS) who were treated with single (FiO(2)>0.30 without need of MV) or multiple (FiO(2)>0.40 without need of MV) INSURE procedures.
Results:
Seventy-five infants were studied: 53 (71%) received single INSURE and 22 (29%) received multiple INSURE procedures. Infants in the single and multiple groups had similar rates of need of MV (15 vs. 23%) and occurrence of BPD (9 vs. 9%), although the latter were more immature and affected by more severe RDS (higher FiO(2), lower a/ApO(2), and pO(2)/FiO(2)) than the former.
Conclusions:
Single and multiple INSURE procedures were followed by similar respiratory outcome in a cohort of extremely preterm infants. Further studies are warranted to evaluate whether the multiple INSURE strategy enhances the success rate of INSURE in preventing the need of MV and the occurrence of BPD.
