Background and Aims Respiratory Distress Syndrome can be treated with the INtubation-SURfactant-Extubation procedure (INSURE). INSURE-failure, with the need for re-intubation and mechanical ventilation, is common. We studied predictors of INSURE-failure to identify high-risk neonates that may benefit from staying intubated and mechanically ventilated after surfactant.

Methods We studied 363 very preterm infants (< 32 weeks) born 1998–2010 and treated with surfactant. Data were systematically retrieved from their medical records. We defined INSURE as extubation within 2 hours of intubation, and INSURE-failure as re-intubation within 72 hours.

Results Currently 219 of these 363 patients have been assessed; 96 were treated with INSURE (Table) and 123 needed prolonged mechanical ventilation. Newborns treated with INSURE had a median gestational age of 29 weeks and a median birth weight of 1158g.

Conclusion These preliminary results suggest an increased risk of INSURE-failure in infants with a gestational age < 28 weeks, 5 minutes APGAR < 10, and surfactant administration in the delivery room. Keeping these newborns intubated after surfactant may prevent a high-risk re-intubation.