THE EFFECT OF INSURE METHOD IN THE TREATMENT OF RESPIRATORY DISTRESS SYNDROME IN PRETERM INFANTS
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Tóm tắt
Background: The INtubation-SURfactant-Extubation (INSURE) is a method that is often
used to treat the respiratory distress syndrome in preterm infants. Objectives: To evaluate the
effect of INSURE method in the treatment of respiratory distress syndrome in preterm infants.
Patients and Methods: The INSURE method is indicated for newborns with gestational age
of 28-36 weeks with respiratory distress syndrome immediately or a few hours after birth on
clinical manifestations, X ray, and need nCPAP with FiO2 30% to maintain SpO2
from 88-90%.
Results: During the period from Jan 2014 to October 2016, we studied 30 preterm infants with
respiratory distress syndrome that received INSURE method in pediatric department of Bach
Mai Hospital, Hanoi, Vietnam. Of those, there were 7/30 (23.3%) newborns with gestational age
of 28-30 weeks and 16/30 (53.6%) newborns with gestational age of 30-32 weeks. The average
birth weight is: 1103.3 ± 196 g (900g-1700g). There were 23.3% pregnancies with diabetes
mellitus and there were 46.6% pregnancies injected with antenatal corticosteroids. Chest
Xray imaging showed that there were 46.7% hyaline membrane disease of stage II, 33.3% of
stage III, and 20% of stage IV. Thirty (100%) preterm infants were used surfactant with dose of
100mg/kg in the first time and no one were used surfactant the second time or more. There were
46.7% preterm infants using INSURE method within the first 6 hours of age and there were only
10.3% preterm infants using this method after 12 hours of age. Seventeen (56.7%) infants were
successfully treated with the INSURE method. Clinical signs, chest X ray and blood gas analysis
were markedly improved after 6 to 48 hours of using INSURE method. There were 3 (10%) infants
with hemorrhagic pulmonary complications, 1 (3.3%) with pneumothorax and no one with
bronchopulmonary dysplasia. Predicting factors of INSURE failure is very low birth weight and
gestation, severe respiratory distress and hyaline membrane disease of stage II, IV. Conclusions:
The INSURE method is well applied to the preterm infants with a particularly high percentage
of success in the group of infants aged 30 weeks, weighing 1000g or more, the Silverman score
below 5 points and hyaline membrane disease of stage II.
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