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Intubation-Surfactant: Extubation on Continuous Positive Pressure Ventilation. Who are the Best Candidates?
Maria Livia Ognean1, Silvia-Maria Stoicescu2, Oana Boantă1
1Clinical County Emergency Hospital Sibiu, Neonatology Department, Sibiu, Romania.
Insights
The INSURE strategy for preterm infants (gestational age ≤ 32 weeks) has a high failure rate. Factors like low Apgar scores and reduced oxygen saturation at birth are linked to INSURE failure, necessitating mechanical ventilation.
Area of Science:
- Neonatal Medicine
- Pediatric Respiratory Care
- Perinatal Research
Background:
- Respiratory distress syndrome (RDS) is a primary cause of morbidity and mortality in preterm infants.
- The INtubate-SURfactant-Extubation (INSURE) strategy is often preferred over mechanical ventilation for very low birth weight neonates due to improved alveolar stability.
Purpose of the Study:
- To determine factors associated with the failure of the INSURE strategy in preterm infants with a gestational age of 32 weeks or less.
Main Methods:
- A retrospective cohort study analyzed data from the Romanian National Registry for RDS patients (2010-2011).
- Preterm infants (≤ 32 weeks gestational age) were categorized into those successfully treated with INSURE and those requiring mechanical ventilation within 72 hours.
Main Results:
- Of 637 infants, 57 (8.9%) received INSURE, with a 54.4% success rate.
- Infants requiring mechanical ventilation showed significantly lower Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation during resuscitation.
- While successful INSURE was associated with higher gestational age, birth weight, and FiO2, these were not statistically significant.
Conclusions:
- Increased INSURE failure rates in preterm infants (≤ 32 weeks gestation) are linked to complicated pregnancies.
- Lower Apgar scores and reduced peripheral oxygen saturation during resuscitation are significant indicators of potential INSURE failure.
Introduction:
Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability.
Aim Of The Study:
To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks.
Materials And Methods:
This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2 ), those who needed mechanical ventilation within seventy two hours after INSURE.
Results:
A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty seven cases (8.9%) [ Group 1] and was successful in thirty one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5).
Conclusion:
In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.
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