Risk factors for the failure of the INSURE strategy in premature infants with respiratory distress syndrome / 中华实用儿科临床杂志

Objective@#To analyze the risk factors for the failure of the intubate-surfactant-extubate to continuous positive airway pressure(INSURE) strategy in preterm infants with respiratory distress syndrome(RDS).@*Methods@#Premature infants with gestation age<34 weeks and hospitalized between August 2016 and November 2018 in Department of Neonatology, Xiamen Maternal and Child Health Hospital were eligible for this descriptive study, and were classified into 2 groups: INSURE success group (281 cases), and INSURE failure group(70 cases), according to whether the infants need to be re-intubated and have invasive ventilator therapy within 72 hours after birth.The clinic information of premature infants in different groups were analyzed.@*Results@#The failure rate of INSURE strategy was 19.9%(70/35I cases). Compared with the success group, the premature infants in failure group had smaller gestational age[31.9(30.0, 32.6)weeks] and lower 1 minute Apgar score(8.0±1.9) scores (Z=10.533, t=2.354, all P<0.05). The incidence of male infants (74.3%), patent ductus arteriosus(PDA) (12.9% without PDA, 26.8% <0.25 cm, 28.3% ≥0.25 cm) and maternal placental abruption was higher (21.4%), and radiological grade (grade 1 was 2.5%, grade 2 was 16.1%, grade 3 was 30.3%, and grade 4 was 66.7%) was more severe (χ2=41.169, P<0.05). The use rate of antepartum glucocorticoid (28.3% without use, 24.9% for partial treatment and 14.4% for full treatment) was lower (χ2=7.315, P<0.05). Logistic regression analysis showed that no use of antepartum glucocorticoid(OR=0.634, 95%CI: 0.423-0.951, P=0.027), placental abruption(OR=2.203, 95%CI: 1.024-4.738, P=0.043), male infants(OR=2.475, 95%CI: 1.259-4.867, P=0.009), low gestational age(OR=0.835, 95%CI: 0.707-0.986, P=0.033), severe radiological grade(OR=2.829, 95%CI: 1.886-4.245, P=0.000), and PDA(OR=1.550, 95%CI: 1.040-2.311, P=0.032)were the risk factors for INSURE failure.@*Conclusions@#Placental abruption, male infants, lower gestational age, severe RDS grading, and PDA are risk factors for the failure of the INSURE strategy in preterm infants with respiratory distress syndrome.Antepartum glucocorticoid treatment can improve success rate of INSURE treatment.

Risk factors for the failure of the INSURE strategy in premature infants with respiratory distress syndrome / 中华实用儿科临床杂志

Objective To analyze the risk factors for the failure of the intubate-surfactant-extubate to continuous positive airway pressure (INSURE) strategy in preterm infants with respiratory distress syndrome (RDS).Methods Premature infants with gestation age ＜ 34 weeks and hospitalized between August 2016 and November 2018 in Department of Neonatology,Xiamen Maternal and Child Health Hospital were eligible for this descriptive study,and were classified into 2 groups:INSURE success group (281 cases),and INSURE failure group (70 cases),according to whether the infants need to be re-intubated and have invasive ventilator therapy within 72 hours after birth.The clinic information of premature infants in different groups were analyzed.Results The failure rate of INSURE strategy was 19.9％ (70/35I cases).Compared with the success group,the premature infants in failure group had smaller gestational age [31.9 (30.0,32.6) weeks] and lower 1 minute Apgar score (8.0 ± 1.9) scores (Z =10.533,t =2.354,all P ＜0.05).The incidence of male infants (74.3％),patent ductus arteriosus (PDA) (12.9％ without PDA,26.8％ ＜0.25 cm,28.3％ ≥ 0.25 cm) and maternal placental abruption was higher (21.4％),and radiological grade (grade 1 was 2.5％,grade 2 was 16.1％,grade 3 was 30.3％,and grade 4 was 66.7％) was more severe (x2 =41.169,P ＜ 0.05).The use rate of antepartum glucocorticoid (28.3 ％ without use,24.9％ for partial treatment and 14.4％ for full treatment) was lower (x2 =7.315,P ＜ 0.05).Logistic regression analysis showed that no use of antepartum glucocorticoid (OR =0.634,95％ CI:0.423-0.951,P =0.027),placental abruption (OR =2.203,95％ CI:1.024-4.738,P =0.043),male infants (OR =2.475,95 ％ CI:1.259-4.867,P =0.009),low gestational age (OR =0.835,95％ CI:0.707-0.986,P =0.033),severe radiological grade (OR =2.829,95 ％ CI:1.886-4.245,P =0.000),and PDA (OR =1.550,95 ％ CI:1.040-2.311,P =0.032) were the risk factors for INSURE failure.Conclusions Placental abruption,male infants,lower gestational age,severe RDS grading,and PDA are risk factors for the failure of the INSURE strategy in preterm infants with respiratory distress syndrome.Antepartum glucocorticoid treatment can improve success rate of INSURE treatment.

The clinical progress of InSurE technique in the neonates / 国际儿科学杂志

The lack of pulmonary surfactant(PS) and the immature of lung structure can cause neonatal respiratory distress syndrome (NRDS).Pulmonary surfactant,noninvasive ventilation,such as nasal continuous positive airway pressure(nCPAP) and the InSurE technique(intubation-surfactant-extubation) are the important methods for the management of NRDS.In this paper,the application and the research progress of the three strategies for NRDS,especially the clinical advantages and progress of InSurE technique,are summarized as follows.