Factores de riesgo asociados a la falla en el procedimiento INSURE (Intubación - Surfactante - Extubación) para la administración de surfactante en recién nacidos prematuros < 1,500 g

Neonatal Respiratory Distress Syndrome (RDS) is caused by pulmonary surfactant deficiency. The initial respiratory support is currently nasal continuous positive airway pressure (Nasal CPAP), and is associated with the decreased need of intubation and mechanical ventilation. The INSURE procedure (Intubation-Surfactant-Extubation) for surfactant administration, is associated with a lower need of supplementary oxygen at 28 days of life. The aim of this study is to identify the frequency of failure of the INSURE procedure, defined as the need for re-intubation in the following 72 hours, the risk factors and neonatal outcomes associated with the failure of this procedure.

Material and methods

An observational, retrospective, analytical study was conducted that included all newborns with birth weight <1500 g, and in whom surfactant was administered using the INSURE procedure, between 1 March 2011 and 31 March 2014.

Results

A total of 183 cases were managed using the INSURE procedure, finding that 38.8% of the failures were due to the technique, with the main cause being apnoea. Risk factors found were, a lower gestational age, lower birth weight, and a higher grade of respiratory distress prior to using INSURE. Within the neonatal outcomes, a significant association was found with the increased use of mechanical ventilation, days of supplemental oxygen, and bronchopulmonary disease, and mortality in the failure group.

Conclusion

An increased risk of failure in the INSURE procedure was associated with lower gestational age and lower birth weight.