Korean J Pediatr.  2018 Oct;61(10):315-321. 10.3345/kjp.2018.06296.

Transient intubation for surfactant administration in the treatment of respiratory distress syndrome in extremely premature infants

• Koh JW
• Kim JW
• Chang YP

• KMID: 2433697
• DOI: http://doi.org/10.3345/kjp.2018.06296

Abstract

PURPOSE
To investigate the effectiveness of transient intubation for surfactant administration and extubated to nasal continuous positive pressure (INSURE) for treatment of respiratory distress syndrome (RDS) and to identify the factors associated with INSURE failure in extremely premature infants.
METHODS
Eighty-four infants with gestational age less than 28 weeks treated with surfactant administration for RDS for 8 years were included. Perinatal and neonatal characteristics were retrospectively reviewed, and major pulmonary outcomes such as duration of mechanical ventilation (MV) and bronchopulmonary dysplasia (BPD) plus death at 36-week postmenstrual age (PMA) were compared between INSURE (n=48) and prolonged MV groups (n=36). The factors associated with INSURE failure were determined.
RESULTS
Duration of MV and the occurrence of BPD at 36-week PMA were significantly lower in INSURE group than in prolonged MV group (P < 0.05), but BPD plus death at 36-week PMA was not significantly different between the 2 groups. In a multivariate analysis, a reduced duration of MV was only significantly associated with INSURE (P=0.001). During the study period, duration of MV significantly decreased over time with an increasing rate of INSURE application (P < 0.05), and BPD plus death at 36-week PMA also tended to decrease over time. A low arterial-alveolar oxygen tension ratio (a/APO2 ratio) was a significant predictor for INSURE failure (P=0.001).
CONCLUSION
INSURE was the noninvasive ventilation strategy in the treatment of RDS to reduce MV duration in extremely premature infants with gestational age less than 28 weeks.

Keyword

Respiratory distress syndrome; Pulmonary surfactants; Endotracheal intubation; Mechanical ventilation; Extremely premature infants

MeSH Terms

Bronchopulmonary Dysplasia
Gestational Age
Humans
Infant
Infant, Extremely Premature*
Infant, Newborn
Intubation*
Intubation, Intratracheal
Multivariate Analysis
Noninvasive Ventilation
Oxygen
Pulmonary Surfactants
Respiration, Artificial
Retrospective Studies
Oxygen
Pulmonary Surfactants