Risk Factors for Failure of Surfactant Therapy with INSURE Method in Preterm Infants

Backgrounds and Preterm infants are at risk for respiratory distress syndrome. In several studies Continuous Positive Airway Pressure (CPAP) in combination with surfactant is more effective comparing with just CPAP method. This type of treatment is known as Intubation، SURfactant، Extubation (INSURE). This study was aimed to determine the risk factors for the INSURE failure. This descriptive analytic study was conducted in NICU of Al Zahra Hospital. All preterm neonates with gestation age less than 37 weeks who need surfactant replacement therapy according clinical manifestations were investigated. Infants intubated in delivery room were excluded from study. All neonates received surfactant according to INSURE method. Patients who intubated in first 72 hours of INSURE were considered as failure group and neonates without need for intubation were allocated as success group. There were not statistically significant differences regarding gender، mode of delivery، maternal risk factors، and first blood gas analysis between groups. The mean birth weight and gestation age were significantly lower in the failure group were 1342±545g and 28. 7±2. 9 wk، respectively، which were significantly lower than success group (1688±472g and 31±2. 2wk، p<0. 001). Apgar score at 1 and 5 minutes were 5. 7±2. 1 and 7. 5±1. 3 in failure group and 7. 6±1. 5 and 8. 8±1 in success group (p<0. 001). The Fraction of inspired oxygen (FiO2) requirement، severity of disease in chest x-ray، need for repeated doses of surfactant، packed cell transfusion، patent ductus arteriosus and intra-ventricular hemorrhage were significantly different between groups (p<0. 05). preterm neonates with lower gestation age and birth weight، low Apgar score at 1 and 5 minute، higher Fio2 requirement، and higher RDS score are increase the risk for INSURE failure.