Factors associated with INSURE method failure in preterm infants with respiratory distress syndrome

Objective : To identify which factors can predict INSURE failure in preterm infants with respiratory distress syndrome. Study design : A retropective analysis of the prenatal histories, clinical courses and paraclinical data of all inborn infants (birth weight < 2000g) with respiratory distress syndrome treated with INSURE method. Infants were categorized into 2 groups : "INSURE failure group" and " INSURE success group". Results : Seventy infants were eligible to the study. INSURE failure was registered in 26 infants (37.1 %). After control for confounding variables, INSURE failure was significantly associated with CRIB score > 4 with a positive predictive value equals to 80 % (adjusted odds ratio [95 % CI] = 14,81 [1.96-111.56]). Complication rates in INSURE failure group were worse than those in INSURE success group. Conclusion : CRIB score > 4 was the main factor of failure of INSURE method in preterm infants with RDS. However, a prospective randomised controlled trial is needed to determine whether or not infants at risk for INSURE failure are better off being treated with mechanical ventilation. Abbreviations : RDS : Respiratory distress syndrome, SUR : surfactant, INSURE : INtubation SURfactant Extubation, MV : mechanical ventilation, N-CPAP : Nasal continuous positive airway pressure, FiO2 : fraction of inspired oxygen