Clinical Analysis Of INSURE Method During NCPAP In Preterm Infants With Respiratory Distress Syndrome

Objective： Retrospectively analyze the clinical characters andoutcomes of preterm infants with respiratory distress syndrome treatingwith intubation-surfactant-extubation(INSURE) method during nasalcontinuous positive airway pressure (nCPAP) for initial treatment.Methods：From January1,2011to December31,2013,131infantswith gestational age27to36+6weeks and respiratory distress syndrometreating with INSURE during nCPAP for initial treatment were eligible tothe study. Infants were categorized into two groups: failure group(32.1%)and success group(67.9%). We retrospectively analyze the prenatalhistories, clinical courses and auxiliary examination data，such as obstetricinformation, basic conditions, laboratorial results, complications, outcomesand so on.Results：The rate of gestational diabetes mellitus and intrahepaticcholestasis of pregnancy are significantly higher in the failure group（P<0.05）, while analyzing the rate of hypertensive disorders in pregnancy, multiple pregnancy and other obstetric information of both groups, thereare non-significant（P>0.05）. The failure group has significantly lowermean arterial pressure, lower pH, lower base excess and higher hemoglobinthan the success group. However, gender，gestational age, birth weight,1minute and5minute Apgar scores, dose of PS, start time of PS and nCPAPin both groups are non-significant. The rate of severe chest X ray grade（Ⅲ～Ⅳ grade）in failure group and success group were26.2%、11.2%,respectively（χ2=4.741，P=0.029）. As common complications of neonatalrespiratory distress syndrome, the incidence rate of patent ductus arteriosus（96.6%）, persistent pulmonary hypertension of newborn（72.4%）,intracranial hemorrhage（25.9%）and pulmonary hemorrhage （26.2%）are significantly higher in the failure group, while the rate ofbronchopulmonary dysplasia and necrotizing enterocolitis arenon-significant in the study. There has higher mortality within28days afterbirth in the failure group, in addition, those who maintain normal oxygensaturation without oxygenation successfully have longer aerobic time andhospital stay in the failure group，while the time of total enteral nutritionand recovery of birth weight are non-significant.Conclusion：Not all preterm infants with respiratory distress syndromecan be successfully managed with INSURE technique, in addition, infantswho fail this modality may suffer the consequences of delayed mechanical ventilation. Low mean arterial pressure, low pH, low base excess andsevere chest X ray grade maybe risk factors of the failure of INSUREtechnique in preterm infants with respiratory distress syndrome.