The Turkish Journal of Pediatrics 2014 , Vol 56 , Num 3
INSURE Method (INtubation-SURfactant-Extubation) in Early and Late Premature Neonates with Respiratory Distress: Factors Affecting the Outcome and Survival Rate
1Department of Pediatrics, Taleghani Hospital, Shahid-Beheshti University of Medical Sciences, and 2Medical Sciences Research Center, Islamic-Azad University of Tehran Medical Branch, Tehran, Iran. E-mail: We studied the effects of administering exogenous surfactant for the treatment of respiratory distress in premature neonates (born before 37 weeks of gestational age [GA]) and compared the role of different risk factors on the outcome as well as survival rate.

All the neonates (242) suffered from moderate to severe respiratory distress, identified by clinical signs, chest X-ray, respiratory distress syndrome (RDS) score >6, and blood gas measurements. All the neonates included were treated by administering surfactant (Beractant or Poractant alfa, dosage 100 mg/kg).

The INSURE method was “successful” in 74% of patients, meaning there was no need for a second dose of surfactant or mechanical ventilation repetition. The factors that determined the “success” (Table II) were as follows: type of delivery, weight, GA, and number of fetuses. The factors affecting survival were: number of fetuses, mechanical ventilation dependency, pregnancy complications, and type of surfactant. The INSURE method reduced mortality (91.3% survived). Keywords : respiratory distress, respiratory distress syndrome (RDS), surfactant, INSURE method, mechanical ventilation.

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