Early risk factors for the failure of the INSURE strategy in premature infants with respiratory distress syndrome / 中国新生儿科杂志

ABSTRACT

Objective:To study the early risk factors for the failure of INtubation-SURfactant-Extubation (INSURE) strategy in preterm infants with respiratory distress syndrome (RDS).Methods:From November 2016 to October 2020, preterm infants with gestational age (GA) <34 weeks admitted to our hospital were enrolled in this study. Infants required invasive ventilation within 72 hours after extubation were assigned into INSURE failure group and other infants INSURE success group. SPSS 25.0 was used to compare the clinical data of the two groups and Logistic regression analysis was used to analyze the independent risk factors of INSURE failure.Results:The incidence of INSURE strategy failure was 25.0% (34/136). The antenatal dexamethasone use, GA, birth weight, 1 min Apgar score, 5 min Apgar score, respiratory index (PaO 2/FiO 2) and mean hemoglobin (Hb) in INSURE failure group were significantly lower than INSURE success group ( P<0.05). INSURE failure group had significantly delayed use of first-time pulmonary surfactant (PS), longer duration of positive pressure ventilation resuscitation, higher respiratory score in Apgar, higher procalcitonin (PCT) level, more placental chorioamnionitis and more RDS radiological grade ≥3 cases than INSURE success group ( P<0.05). Logistic regression analysis showed that respiratory score ≥8 ( OR=10.609, 95% CI 2.630~42.797, P=0.001), RDS radiological grade ≥ 3 ( OR=8.813, 95% CI 2.022~38.423, P=0.004) and Hb<145 g/L ( OR=9.074, 95% CI 1.771~46.147, P=0.008) were independent risk factors for INSURE failure. And antenatal dexamethasone use ( OR=0.270, 95% CI 0.075~0.978, P=0.046) was a protective factor for INSURE failure. Conclusions:Respiratory score ≥8 in Apgar, RDS radiological grade ≥3, Hb<145 g/L and the insufficient use of antenatal dexamethasone are independent risk factors for INSURE failure.