Perinatology.  2021 Sep;32(3):125-132. 10.14734/PN.2021.32.3.125.

Comparison of Respiratory Outcome between the Surfactant without Endotracheal Tube Intubation and the Intubation-SurfactantExtubation Techniques in Extremely Low Gestational Age Neonates with Respi­ratory Distress Syndrome

  • 1Division of Neonatology, Department of Pediatrics, Children’s Hospital, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea


The aim of this study was to determine whether there were differences in respiratory out comes of extremely low gestational age neonates according to the surfactant without endotracheal tube intubation (SURE) technique or the intubation-surfactant-extubation (INSURE) technique in treating respiratory distress syndrome.
Preterm infants less than 28 weeks of gestational age between January 2015 and De cember 2020 were retrospectively reviewed. Demographic and outcome variables, the respiratory outcomes including incidence of bronchopulmonary dysplasia (BPD) and pulmonary acuity score (PAS) were compared between the infants who received SURE and INSURE.
A total of 53 infants (SURE, 18; INSURE, 35) were analyzed. There were differences between SURE and INSURE groups in birth weight (919.5 g vs. 815.6 g, P=0.037) and Apgar score (1 minute: 6 vs. 5, P=0.037; 5 minutes: 8 vs. 7, P=0.016). Positive pressure ventilation rate at delivery room, con tinuous positive airway pressure failure rate, the second dose of surfactant administration, the duration of invasive and/or noninvasive respiratory support, and the incidence of BPD were not significantly different between the two groups. The PAS at 7 days of life (DOL) was lower than at birth in SURE group (P=0.048). However, there were no differences between PAS at birth and at postmenstrual age 36 weeks.
Respiratory outcomes including incidence of BPD were not different between the SURE and INSURE groups. Nevertheless, PAS at 7 DOL decreased after the SURE technique.


Pulmonary surfactants; Respiratory distress syndrome; Bronchopulmonary dysplasia
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