Criteria for Using INSURE in Management of Premature Babies with Respiratory Distress Syndrome

Abstract

Introduction:Respiratory distress syndrome (RDS) is defined as acute respiratory distress caused by surfactant deficiency that disturbs gas exchange in preterm infants. It is one of the most common neonatal problems and has been considered to be the most common cause of mortality and morbidity in preterm babies.Aim:In this study, different variables were studied to predict factors for INSURE failure that might help in choosing infants for this procedure early.Methods:Sixty three (63) patients were enrolled in this study as they met the inclusion criteria. All neonates were intubated briefly less than 2 hours, given natural surfactant in the dose of 3 ml/kg. As soon as it was appropriate and the neonate was stable in the form of normal heart rate and oxygenation, extubation was done and the baby connected to NCPAP at a pressure of 6 cmH2O. INSURE failure was considered if the patient needed mechanical ventilation for more than 72 hours while INSURE success was considered if we were able to wean the patient from CPAP or if the patient didn’t need mechanical ventilation in the first 72 hours after surfactant administration. The indications for mechanical ventilation after INSURE procedure were respiratory distress with desaturation (02 sat less than 90%), recurrent apnea, Pco2 more than 60 mmHg.Results:Since INSURE procedure is being largely applied in the neonatal intensive care units, it is important to determine the candidate neonate for this procedure with the minimum failure rate. Although the sample of our study is small, but we can suggest that neonate with gestational age less than 28, birth weight less than 1000 gm, umbilical PH of less than 7, low Apgar score and anemic patients are at high risk for INSURE failure.Conclusion:Early diagnosis of PDA and IVH is essential to avoid INSURE method in these patients.

2019 Year in Review: Neonatal Respiratory Support

“…Due the methodological heterogeneity of included studies, it was not possible to create a clinical tool to distinguish infants who could be successfully extubated after the INSURE technique from those who may benefit from continued mechanical ventilation. Similarly, Awaysheh et al 62 described a failure rate of 25% in subjects < 30 weeks gestational age who were treated with the INSURE technique and mechanical ventilation for < 2 h. They reported that gestational age < 28 weeks, birthweight < 1,000 g, and pH < 7.0 were risk factors for INSURE failure.…”

Rotating nasal masks with nasal prongs reduces the incidence of moderate to severe nasal injury in preterm infants supported by noninvasive ventilation

“…Preterm birth stands out as the main risk factor for respiratory failure due to incomplete anatomical differentiation and an inadequate amount of pulmonary surfactant, leading to diffuse alveolar atelectasis, edema and cell injury. ( 1 - 3 ) These conditions justify the need for ventilatory support and admission to the neonatal intensive care unit (ICU). ( 1 - 5 )…”