Ognean Maria Livia, Stoicescu Silvia-Maria, Boantă Oana, Năstase Leonard, Gliga Carmen, Cucerea Manuela
Clinical County Emergency Hospital Sibiu, Neonatology Department, Sibiu, Romania.
University of Medicine and Pharmacy Carol Davila Bucuresti, Institute of Mother and Child Care - Polizu, Neonatology Department, Bucharest, Romania.
J Crit Care Med (Targu Mures). 2016 May 9;2(2):73-79. doi: 10.1515/jccm-2016-0010. eCollection 2016 Apr.
Respiratory distress syndrome (RDS) continues to be the leading cause of illness and death in preterm infants. Studies indicate that INSURE strategy (INtubate-SURfactant administration and Extubate to nasal continuous positive airway pressure [nCPAP]) is better than mechanical ventilation (MV) with rescue surfactant, for the management of respiratory distress syndrome (RDS) in very low birth weight (VLBW) neonates, as it has a synergistic effect on alveolar stability.
To identify the factors associated with INSURE strategy failure in preterm infants with gestational age (GA) ≤ 32 weeks.
This was a retrospective cohort study, based on data collected in the Romanian National Registry for RDS patients by three regional (level III) centers between 01.01.2010 and 31.12.2011. All preterm infants of ≤ 32 weeks GA were included. Prenatal and neonatal information were compared between (Group 1), the preterm infants successfully treated using INtubation-SURfactant-Extubation on nasal CPAP (INSURE) strategy and (Group 2 ), those who needed mechanical ventilation within seventy two hours after INSURE.
A total of 637 preterm infants with GA ≤ 32 weeks were included in the study. INSURE strategy was performed in fifty seven cases (8.9%) [ Group 1] and was successful in thirty one patients (54.4%). No differences were found as regards the studied prenatal and intranatal characteristics between (Group 1) and Group 2 who needed mechanical ventilation. Group 2 preterm infants who needed mechanical ventilation within 72 hours after INSURE had significantly lower mean Apgar scores at 1 and 5 minutes and lower peripheral oxygen saturation (SpO2) during resuscitation at birth (p<0.05). Successful INSURE strategy was associated with greater GA, birth weight (BW), fraction of inspired oxygen (FiO2) during resuscitation, and an increased mean dose of surfactant but these associations were not statistically significant (p>0.5).
In preterm infants ≤ 32 weeks gestation, increased INSURE failure rates are associated with complicated pregnancies, significantly lower Apgar scores at 1 and 5 minutes, and lower peripheral oxygen saturation during resuscitation.
呼吸窘迫综合征（RDS）仍然是早产儿发病和死亡的主要原因。研究表明，INSURE策略（气管插管-表面活性剂给药并拔管至鼻持续气道正压通气[nCPAP]）在极低出生体重（VLBW）新生儿呼吸窘迫综合征（RDS）的管理中优于机械通气（MV）联合挽救性表面活性剂治疗，因为它对肺泡稳定性具有协同作用。
确定胎龄（GA）≤32周的早产儿中与INSURE策略失败相关的因素。
这是一项回顾性队列研究，基于罗马尼亚国家RDS患者登记处三个地区（三级）中心在2010年1月1日至2011年12月31日期间收集的数据。纳入所有GA≤32周的早产儿。比较了（第1组）使用气管插管-表面活性剂-拔管至鼻CPAP（INSURE）策略成功治疗的早产儿与（第2组）在INSURE后72小时内需要机械通气的早产儿的产前和新生儿信息。
共有637例GA≤32周的早产儿纳入研究。57例（8.9%）实施了INSURE策略[第1组]，其中31例（54.4%）成功。在（第1组）和需要机械通气的第2组之间，所研究的产前和产时特征方面未发现差异。在INSURE后72小时内需要机械通气的第2组早产儿在出生后1分钟和5分钟时的平均阿氏评分显著较低，出生复苏期间外周血氧饱和度（SpO2）也较低（p<0.05）。成功的INSURE策略与更大的GA、出生体重（BW）、复苏期间的吸入氧分数（FiO2）以及表面活性剂平均剂量增加有关，但这些关联无统计学意义（p>0.5）。
在胎龄≤32周的早产儿中，INSURE失败率增加与复杂妊娠、出生后1分钟和5分钟时显著较低的阿氏评分以及复苏期间较低的外周血氧饱和度有关。
