Surfactant Therapy Using INSURE Method (Intubation- SURfactant-Extubation) in Management of Respiratory Distress Syndrome and Risk Factors Contributing to Failure of This
Background: The INSURE method (Intubation-SURfactant-Extubation) is increasingly
being used to treat the respiratory distress syndrome in preterm infants and associated
with declining the necessity for mechanical ventilation and reducing its associated adverse
Objectives: To evaluate the effectiveness of surfactant therapy using INSURE method in
the management of respiratory distress syndrome and to identify the risk factors
associated with its failure.
Methods: A retrospective descriptive cross-sectional study was conducted in neonatal
intensive care unit in Al- Yarmook Teaching Hospital, Baghdad, Iraq from April through
October 2014. All preterm neonates (Gestational age 24-34 weeks) with clinical signs and
radiological findings suggestive of respiratory distress syndrome and received surfactant
by INSURE method were enrolled in this study and allocated into INSURE success and
INSURE failure group depending whether they need re- intubation and mechanical
ventilation or not.
Results: The total number of neonates enrolled in this study was one hundred five; of
whom number of males was 60 patients (57.1%) compared with 45 females (42.9%). The
INSURE method was successful in 71 neonates (67.6%). The mean birth weight and
gestational age in the failure group were 1135(± 296) grams and 28.47(± 2.402) weeks
respectively, and were significantly lower than the success group 1426(± 327) grams and
30.5(± 1.969) weeks respectively. This study also showed that the INSURE method was
successful in 36 among 42 (85.7%) neonates with gestational age > 30 weeks while
succeed in 35 among 63(55.6 %) neonates with gestational age ≤ 30 weeks. The Apgar
scores at 5 min where significantly lower in the failure group up in comparison with
success group (the Apgar score between 4 and 6 was present in 31.4% of success group
where as 68.6% of failure group). Severe respiratory distress syndrome was significantly
more common in the failure group (75.7%) than in the success group (24.3%).
This study showed that the more prolonged CPAP (continuous positive airway pressure)
treatment after surfactant administration, the more the INSURE method failed. Sepsis,
recurrent apnea and pneumothorax were significantly more common in the failure group.
Conclusion: INSURE method is very effective method in the management of respiratory
distress syndrome. It is associated with decline in the neonatal mortality rate. Preterm
neonates with lower birth weight, lower gestational age, lower Apgar score, severe
respiratory distress syndrome with prolonged CPAP treatment duration after surfactant
administration have an increased risk of failure of this method. Complications during the
course of treatment such as Sepsis, recurrent apnea and pneumothorax may adversely
affect the INSURE method success.
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