Efficacy of INSURE during nasal CPAP in preterm infants with respiratory distress syndrome

F. Leone, D. Trevisanuto, F. Cavallin, M. Parotto, V. Zanardo

Research output: Contribution to journalArticlepeer-review


Aim. INSURE (INtubation, SURfactant, Extubation) is a proven complement of nasal CPAP (nCPAP) for respiratory distress syndrome (RDS) treatment of preterm infants. Early administration is characterized by greater success. We aimed to determine the efficacy and failure or other respiratory outcomes of INSURE administration during nasal continuois positive airway pressure (nCPAP) treatment of RDS. Methods. Among 824 premature infants neonatal intensive care unit (NICU) admitted at Padua University Hospital during 2007-2009, 209 (25.4%) were managed by surfactant replacement (200 mg/kg, Curosurf®) if required >45% oxygen ("rescue" treatment), including 42 (20.1%) during nCPAP. Each premature infant treated with INSURE during nasal CPAP was compared to 2 consecutive control infants treated with surfactant during mechanical ventilation, matched for antenatal steroids, delivery route, gestational age, and sex. Results. Infants with RDS, treated with nC-PAP and INSURE-complement (N.=25), were comparable in Apgar score, need of PPV at birth, birth weight, pre-surfactant FiO2 and timing of surfactant replacement to controls. However, nCPAP and INSURE-complement was superior in terms both of oxygenation, evaluated as post-treatment FiO2 (Median, [IQR], 26 [21-40] vs. 21 [21-29]; P=0.03) and (a-A) pO2 (0.48 [0.45-0.60] vs. 0.58 [0.53-0.72]; P=0.03). The improved oxygenation was sustained over the following days. In ad dition, premature infants treated with nCPAP and INSURE-complement developed less respiratory co-morbidities, including pneumot-horax, borncopulmonary disease (BPD), and BPD and death (P=0.04). Conclusion. INSURE-complement of nasal CPAP has a superior efficacy in terms of oxygenation improvement, maintenance of optimal oxygenation, and reduction of respiratory comorbidities respect to "rescue" surfactant administration during mechanical ventilation.

Original languageEnglish
Pages (from-to)187-192
Number of pages6
JournalMinerva Pediatrica
Issue number2
Publication statusPublished - Apr 2013


  • Bronchopulmonary dysplasia
  • Continuous positive airway pressure
  • Respiratory distress syndrome
  • Surface-active agents

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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