The INSURE method in preterm infants of less than 30 weeks' gestation.
OBJECTIVE
Our aim was to identify the clinical characteristics which could distinguish infants who can be managed with INSURE (intubatio-surfactant-extubation) method for preventing mechanical ventilation (MV) and which could predict INSURE success or failure.


METHODS
Inborn infants with gestational age <30 weeks were Infants were categorised into three groups: (1) infants who needed MV in the delivery room; (2) infants spontaneously breathing who were treated only with NCPAP; (3) infants who were treated with INSURE method.


RESULTS
We studied 125 infants: 30 (24%) required MV, 75 (60%) received INSURE treatment, and 20 (16%) were treated with NCPAP. Sixty-eight (91%) infants were successfully treated with the INSURE method. Infants in the success group had less severe RDS and less occurrence of sepsis and pneumothorax, lower mortality, and shorter duration of stay in the NICU than infants in the failure group. A birth weight <750 g, pO(2)/FiO(2) <218, and a/ApO(2) <0.44 at the first blood gas analysis were independent risk factor for INSURE failure.


CONCLUSIONS
The INSURE method can be applied to the majority of extremely preterm infants and is followed by a high percentage of success.
Dani
Carlo
C
Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital of Florence, Viale Morgagni, 85, 50134 Florence, Italy. cdani@unifi.It
Corsini
Iuri
I
Bertini
Giovanna
G
Fontanelli
Giulia
G
Pratesi
Simone
S
Rubaltelli
Firmino F
FF
D001724:Birth Weight / Q000502:physiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D019102:Infant, Very Low Birth Weight / Q000502:physiology; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000628:therapy
D011663:Pulmonary Surfactants