Comparison Of INSURE Method with Conventional Mechanical Ventilation after Surfactant Administration in Preterm Infants with Respiratory Distress Syndrome: Therapeutic Challenge
Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS.
Reininger A, Khalak R, Kendig JW, et al. Surfactant administration by transient intubation in infants 29 to 35 weeks' gestation with respiratory distress syndrome decreases the likelihood of later mechanical ventilation: a randomized controlled trial. J Perinatol 2005;25(11):703-8.
Rodriguez RJ. Management of respiratory distress syndrome: an update. Respir Care 2003;48(3):279-86.
Stevens TP, Harrington EW, Blennow M, et al. Early surfactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome. Cochrane Database Syst Rev 2007;(4):CD003063.
Bohlin K, Gudmundsdottir T, Katz-Salamon M, et al. Implementation of surfactant treatment during continuous positive airway pressure. J Perinatol 2007;27(7):422-7.
Dan1i C, Corsini I, Bertini G, et al. The INSURE method in preterm infants of less than 30 weeks' gestation. J Matern Fetal Neonatal Med 2010;23(9):1024-9.
Bohlin K, Jonsson B, Gustafsson AS, et al. Continuous positive airway pressure and surfactant. Neonatology 2008;93(4):309-15.
Moretti C, Papoff P, Giannini L, et al. Surfactant and non invasive ventilation. Pediatr Med Chir 2005;27(5):26-9.
Kribs A, Pillekamp F, Hunseler C, et al. Early administration of surfactant in spontaneous breathing with nCPAP: feasibility and outcome in extremely premature infants (postmenstrual age =27 weeks). Paediatr Anaesth 2007;17(4):364-9.
Sankar MJ, Agarwal R, Deorari AK, et al. Chronic lung disease in newborns. Indian J Pediatr 2008;75(4):369-76.
Downes JJ, Vidyasagar D, Boggs TR Jr, et al. Respiratory distress syndrome of newborn infants. I. New clinical scoring system (RDS score) with acid--base and blood-gas correlations. Clin Pediatr (Phila) 1970;9(6):325-31.
Verder H, Robertson B, Greisen G, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish- Swedish Multicenter Study Group. N Engl J Med 1994;331(16):1051-5.
Escobedo MB, Gunkel JH, Kennedy KA, et al. Early surfactant for neonates with mild to moderate respiratory distress syndrome: a multicenter, randomized trial. JnPediatr 2004;144(6):804-8.
Cherif A, Hachani C, Khrouf N. Risk factors of the failure of surfactant treatment by transient intubation during nasal continuous positive airway pressure in preterm infants. Am J Perinatol 2008;25(10):647-52.
Andersen T, Holm HS, Kamper J. Surfactant treatment of newborn infants receiving continuous positive airway pressure treatment. Ugeskr Laeger 2006;168(43):3723-7.
Dani C, Berti E, Barp J. Risk factors for INSURE failure in preterm infants. Minerva Pediatr 2010;62(3 Suppl 1):19-20.
Chotigeat U, Ratchatanorravut S, Kanjanapattanakul W. Compare severity of bronchopulmonary dysplasia in neonates with respiratory distress syndrome treated with surfactant to without surfactant. J Med Assoc Thai 2011;94(Suppl 3):S35-40.
Lee HJ, Kim EK, Kim HS, et al. Chorioamnionitis, respiratory distress syndrome and bronchopulmonary dysplasia in extremely low birth weight infants. J Perinatol 2011;31(3):166-70.
Woynarowska M, Rutkowska M, Szamotulska K. Risk factors, frequency and severity of bronchopulmonary dysplasia (BPD) diagnosed according to the new disease definition in preterm neonates. Med Wieku Rozwoj 2008;12(4 Pt 1):933-41.
Moss TJ. Respiratory consequences of preterm birth. Clin Exp Pharmacol Physiol 2006;33(3):280-4.
Blennow M, Jonsson B, Dahlstrom A, et al. Lung function in premature infants can be improved. Surfactant therapy and CPAP reduce the need of respiratory support. Lakartidningen 1999;96(13):1571-6.
Verder H, Albertsen P, Ebbesen F, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics 1999;103(2):E24.
Dani C, Corsini I, Bertini G, et al. Effect of multiple INSURE procedures in extremely preterm infants. J Matern Fetal Neonatal Med 2011;24(12):1427-31.
Dani C, Corsini I, Poggi C. Risk factors for intubationsurfactant- extubation (INSURE) failure and multiple INSURE strategy in preterm infants. Early Hum Dev 2012;88( Suppl 1):S3-4.
Kendig JW, Ryan RM, Sinkin RA, et al. Comparison of two strategies for surfactant prophylaxis in very premature infants: a multicenter randomized trial. Pediatrics 1998;101(6):1006-12.
Copyright (c) Acta Medica Iranica
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.