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Efficacy of INSURE during nasal CPAP in preterm infants with respiratory distress syndrome

F Leone1, D Trevisanuto, F Cavallin

  • 1Department of Pediatrics, Padua University, Padua, Italy.

Minerva Pediatrica
|April 25, 2013
PubMed

Insights

The INSURE (INtubation, SURfactant, Extubation) method, combined with nasal CPAP (nCPAP), improves oxygenation and reduces respiratory issues in preterm infants with respiratory distress syndrome (RDS). This approach is more effective than rescue surfactant treatment during mechanical ventilation.

Area of Science:

  • Neonatal Medicine
  • Pediatric Pulmonology
  • Critical Care

Background:

  • Respiratory distress syndrome (RDS) is a common condition in preterm infants.
  • Nasal continuous positive airway pressure (nCPAP) is a standard treatment for RDS.
  • The INSURE (INtubation, SURfactant, Extubation) procedure is an adjunct to nCPAP for RDS management.

Purpose of the Study:

  • To evaluate the efficacy of the INSURE method when administered during nCPAP treatment for RDS in preterm infants.
  • To compare respiratory outcomes, including oxygenation and comorbidities, between infants treated with INSURE during nCPAP and those receiving rescue surfactant therapy during mechanical ventilation.

Main Methods:

  • A comparative study of 824 preterm infants admitted to Padua University Hospital (2007-2009).
  • 209 infants received "rescue" surfactant treatment, with 42 treated with INSURE during nCPAP.
  • INSURE-treated infants were matched with controls receiving surfactant during mechanical ventilation based on key perinatal factors.

Main Results:

  • Infants treated with INSURE during nCPAP showed significantly improved oxygenation (post-treatment FiO2 and a-A pO2) compared to controls (P=0.03).
  • Improved oxygenation was sustained in the days following treatment.
  • The INSURE group experienced fewer respiratory comorbidities, including pneumothorax, bronchopulmonary dysplasia (BPD), and BPD with death (P=0.04).

Conclusions:

  • INSURE combined with nCPAP is more effective than rescue surfactant administration during mechanical ventilation for improving and maintaining oxygenation in preterm infants with RDS.
  • This strategy significantly reduces the incidence of respiratory comorbidities.
  • Early INSURE administration during nCPAP represents a superior treatment approach for neonatal respiratory distress.
Abstract

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