title: Is it feasible to identify preterm infants with respiratory distress syndrome for early extubation to continuous positive airway pressure post-surfactant treatment during retrieval?
abstract: OBJECTIVE
  Preterm infants with respiratory distress syndrome (RDS) requiring surfactant treatment are often retrieved mechanically ventilated to the receiving hospital. INSURE (INtubate, SURfactant, Extubate) technique is not routinely performed by Newborn and Pediatric Emergency Transport Services NSW (NETS) during retrieval. This study aims to evaluate the likelihood of using INSURE technique during retrieval. We attempted to study the clinical characteristics of preterm infants with RDS who were favourably extubated (FE) shortly after admission to the receiving hospital.
  
  
  METHODS
  Retrospective study of preterm infants, gestational age (GA) > 28 weeks with RDS requiring retrieval by NETS.
  
  
  RESULTS
  Two hundred twenty-three infants, median GA of 33 weeks (range 29-36), median birthweight 2200 g (1000-4080) were examined. A percentage of 49.7 received CPAP, and 50.3% required MV. Eighteen (16%) infants were FE (<6 h) at receiving hospital. FiO2 on stabilisation (FiO2 (st)) by NETS correlated with FiO2 on admission to receiving hospital (r = 0.863). A percentage of 81 of ventilated infants received premedications including morphine. No significant differences were noted for GA, stabilisation ventilator settings, surfactant dose (mean 155 mg/kg) and mode of transport between FE and non-FE groups. FiO2 (st) post-surfactant treatment was significantly lower in FE compared with non-FE group (mean 0.28 vs. 0.41 respectively). The area under the curve from receiver operating characteristic based on FiO2 (st) was 0.646 (P = 0.050), the sensitivity and specificity of FiO2 (st) cut-off points (between 0.25 and 0.30) was low.
  
  
  CONCLUSIONS
  FiO2 on stabilisation post-surfactant treatment has a weak predictive value and may not be adequate to be used as sole criteria to extubate to CPAP prior to transport. FiO2 at stabilisation should be included as an eligibility criteria for a randomised trial of INSURE during retrieval, but other clinical assessments are needed.
authors.affiliation: New Born Care Centre, Royal Hospital for Women, Sydney, New South Wales, Australia.
authors.forename: Archana
authors.initials: A
authors.lastname: Priyadarshi
authors.forename: Wei Shern
authors.initials: WS
authors.lastname: Quek
authors.forename: Melissa
authors.initials: M
authors.lastname: Luig
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
mesh_terms: D060666:Airway Extubation / Q000379:methods / Q000592:standards*; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010100:Oxygen / Q000008:administration & dosage / Q000032:analysis*; D011247:Pregnancy; D011663:Pulmonary Surfactants / Q000008:administration & dosage / Q000627:therapeutic use*; D012127:Respiratory Distress Syndrome, Newborn / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D012122:Ventilators, Mechanical / Q000592:standards
chemical_list: D011663:Pulmonary Surfactants; D010100:Oxygen
keywords: INSURE; mechanical ventilation; neonatal retrieval; respiratory distress syndrome