Comparative analysis of clinical outcomes in very low birth weight infants with respiratory distress syndrome: surfactant replacement using INSURE technique versus Conventional method at Nakornping Hospital
Keywords:
RDS, BPD, surfactant, INSURE, VLBWAbstract
Introduction: Administering surfactant to preterm infants with respiratory distress syndrome (RDS) using the INSURE method presents advantages over conventional techniques. However, practical limitations persist concerning personnel and resources.
Objectives: The study aimed to compare clinical outcomes between preterm infants weighing less than 1,500 grams with RDS, who received surfactant via INSURE versus conventional methods and to examine the success rate of extubation after surfactant administration via INSURE.
Research Methodology: This retrospective study involved reviewing medical records of preterm infants weighing less than 1,500 grams, experiencing RDS, and receiving surfactant between October 1, 2019, and September 30, 2022. Statistical analysis for main outcomes included Gaussian regression or Logistic regression models based on data characteristics, complemented by inverse propensity score weighting adjustments.
Results: Among the 280 eligible infants, 240 had RDS, and 194 (80.8%) received surfactant - 157 (80.9%) via conventional methods and 37 (19.1%) via INSURE. Both groups exhibited no significant differences in demographics, delivery methods, maternal age, intrapartum antibiotic prophylaxis, or Intrapartum complications. However, the conventional group displayed lower birth weight, gestational age, inborn rate, Apgar score, pregnancy-induced hypertension, and antenatal steroid use. After inverse propensity weighting adjustment, the INSURE group showed significantly lower rates of severe BPD or mortality (OR 0.39, 95% CI 0.16-0.96, p=0.041), ventilator-associated pneumonia (OR 0.26, 95% CI 0.07 – 0.94, p=0.041), and retinopathy of prematurity stage 3 or higher (OR 0.10, 95% CI 0.06 – 0.18, p <0.001) compared to the conventional group. Successful extubation after surfactant administration in the INSURE group was observed in 29 cases (78.4%), while success rate in extremely low birth weight infants was 71.4%. In fail extubation group had higher incidence of patent ductus arteriosus (100%, p=0.006) compared to successful extubation (44.8%).
Conclusion: Administering surfactant via INSURE in a regional hospital setting yields favorable outcomes for extremely low birth weight preterm infants, reducing significant complications. Further development is essential to enhance accessibility.
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