Risk factors for the failure of INSURE strategy in very and extremely low birth weight preterm infants

Abstract

Objective To study the risk factors for failure of INSURE strategy in very and extremely low birth weight preterm (V/ELBW) infants. Method From January 2005 to December 2014, clinical data of 149 preterm infants (gestational age less than 32 weeks) admitted to neonatal department of Tongji Hospital who received intubation-surfactant-extubation (INSURE) strategy were collected. These infants were assigned into two groups: INSURE failure group and INSURE success group, according to whether a second dose of surfactant or mechanical ventilation was needed within 72 hours after first pulmonary surfactant treatment. The clinical characteristics and outcomes between the two groups were compared. Chi square and t tests were used to define the differences between groups. Logistic regression analysis was used to identify the independent risk factors for INSURE failure. Result Among the 1 149 patients, 148 received INSURE treatment, and 113 cases (76.4%) were successfully treated with the INSURE strategy. The infants in the failure group were statistically lower in birth weight, gestation age, antenatal steroids utilization rate, PaO2 and PaO2/FiO2 than those in the success group, while the age of mother, male/female ratio and PaCO2 were higher in the failure group. Logistic regression analysis showed that male (OR=7.440, 95%CI 1.846~29.984), BW 48 mmHg (OR=5.996, 95%CI 2.088~17.213), PaO2/FiO2<205 (OR=3.010, 95%CI 1.033~8.774) were independent risk factors for INSURE failure. Conclusion INSURE strategy failure was associated with gender, birth weight, gestation age, antenatal steroids utilization, PaO2, PaCO2 and PaO2/FiO2 of the first blood gas after birth. BW 48 mmHg and PaO2/FiO2<205 of the first blood gas after birth were independent risk factors for INSURE strategy failure. Key words: Pulmonary surfactants; Continuous positive airway pressure; Risk factors; Intubation-surfactant-extubation; Infant, premature