The InSure Method In Preterm Infants Of Less Than 32 Weeks' Gestation And Risk Factors For Its Failure

Objectives By analyzing clinical characteristics of preterm infants less than 32 weeks,gestation,we aimed to investigate the application of In Sure method and identify the risk factors associated with its failure.Methods We collected clinical data of preterm infants less than 32 weeks,gestation hospitalized in Neonatal Department of Tongji Hospital between January 1, 2005 and December 31, 2014 and analyzed the application of In Sure method. According to whether a second dose of surfactant or mechanical ventilation was needed during 72 hours after surfactant treatment, we categorized the infants into two groups: In Sure failure group and In Sure success group, and then compared the clinical characteristics and outcomes between the two groups. Logistic regression analysis was used to identify the independent risk factors for In Sure failure.Results A tatol of 1149 preterm infants less than 32 weeks,gestation were hospitalized in our hospital between January 1, 2005 and December 31, 2014. In the 1149 patients, 63 of them gave up treatment in the first 24 h after birth, 296 could breath spontaneously without oxygen therapy in the first 72 h after birth, 249 only needed central oxygen supply, 107 were treated only with NCPAP, 286 required MV and 148 received In Sure treatment. One hundred and thirteen(76.35%) infants were successfully treated with the In Sure method. The infants in the failure group were much lower in birth weight, gestation age, antenatal ateroids utilization rate, PO2 and PO2/Fi O2 than those in the succsss group, while the age of mother, male to female ratio and PCO2 were higher in the failure group. Logistic regression analysis showed that male(P=0.005,OR=7.440, 95%CI=1.846-29.984), BW<1000g(P=0.010, OR=9.180, 95%CI=1.716-49.105),PCO2>48mm Hg(P=0.001, OR=5.996, 95%CI=2.088-17.213), PO2/Fi O2<205(P=0.044,OR=3.010, 95%CI=1.033-8.774) were independent risk factors for In Sure failure. Infants in the failure group had higher frequency of PS application, longer duration of oxygen therapy and length of stay, higher incidence of BPD and mortality.Conclusions There was a decreasing need on mechanical ventilation for preterm infants less than 32 weeks,gestation and the In Sure method application grew more and more extensive in our center over the past 10 years, while the success rate of In Sure method had little improvement. We observed that the In Sure method cannot be given to all infants and success all the time, re-intubation and mechanical wentilation were needed sometimes. Male, BW<1000g, PCO2>48mm Hg and PO2/Fi O2<205 at the blood gas before the application of PS were independent risk factors for In Sure failure.