1 Department of Pediatric, School of Medicine, Semnan University of Medical Sciences, Semnan, Iran.

2 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.

3 Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran.


INtubate-SURfactant-Extubate (INSURE) method is one of the effective methods in treatment of infants with respiratory distress syndrome (RDS). This study was performed to predict risk factors for the failure of  INSURE method in treatment of RDS in preterm infants.
Materials and Methods: In this cross-sectional study, 192 infants who born between July 2011 and April 2016 at women and children's hospital of Amiralmoemenin in Semnan, Iran, were included to the study. Inclusion criteria were infants with moderate to severe RDS, 26 to 38 gestational weeks and weighted 500 to 3,500 grams. All patients were treated with INSURE method, then were divided to success and failure INSURE. Severity of RDS was determined by RDS scoring system. The collected data including gender status, gestational age (GA), birth weight (BW), maternal diabetes mellitus, delivery type and neonatal morbidity (including intraventricular haemorrhage (IVH), Necrotizing enterocolitis (NEC) stage 1, sepsis, chronic lung disease (CLD), pneumothorax, and pulmonary bleeding. Statistical analysis was done using SPSS software, version 22.0.
Results: Of the 192 patients, 82 (42.7%) infants were females. The mean GA and BW were 30.25 ± 1.85 weeks and 1950 ± 270 grams, respectively. Of all the patients, 156 infants (81.25%) were born via cesarean section. INSURE failure was observed in 79 infants (41.1 %) and INSURE success was observed in 113 (58.9%). Among the factors, INSURE method failure had a significant relationship with GA, BW, RDS severity and increased probability of IVH, CLD, pneumothorax and pulmonary bleeding (p<0.05). Based on logistic regression analysis, there was a significant relationship between the failure of INSURE method and RDS severity (odds ratio [OR]= 6.31, 95% 95%CI [CI]= 2.07-19.19, P=0.001), and GA OR=0.78, 95% CI= 0.67-0.91, P=0.001).
According to the finding, among the risk factors, only higher severity of RDS and GA were able to predict INSURE method failure in treatment of RDS in preterm infants. Additional studies are recommended in this regard.