Early predictors for INSURE failure in preterm infants with neonatal respiratory distress syndrome: a systematic review.

ABSTRACT

Context: The INtubation-SURfactant-Extubation (INSURE) procedure is a widely-used surfactant administration method to treat preterm infants with respiratory distress syndrome (RDS) but is not always successful.

Objective: To identify early predictive factors for failure of the INSURE procedure.

Data sources: A systematic literature search was performed until December 2015 in MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL).

Study selection: Original studies comparing INSURE success with INSURE failure in preterm infants with RDS were included.

Data synthesis: A predefined data extraction form was used to retrieve data from articles. Methodological quality was assessed using the SIGN checklist. Meta-analysis was performed where possible.

Results: Ten studies out of 516 identified records met inclusion criteria. Methodological quality varied, only 5 studies performed multivariate analysis. We identified 16 different risk factors in total. Evidence for birth weight as a predictor for INSURE failure was inconsistent. There was a significant association between decreasing gestational age and failure risk. RDS severity was assessed in multiple ways, using arterial blood gas values, imaging and scoring systems.

Limitations: Heterogeneous methodology between studies makes it difficult to draw firm conclusions and limits use of these results for clinical decision making.

Conclusion: Extremely low birth weight, low gestational age and severe RDS appear to be risk factors for INSURE failure. However, evidence is inconsistent due to important methodological heterogeneity. Therefore, clinical applicability of these results is limited and implies the need for future large cohort studies on this subject.