A 26-week preterm neonate is being managed on CPAP for RDS. Despite FiO2 of 0.45, SpO2 is persistently 84–88%. The neonatologist decides to initiate INSURE (INtubation-SURfactant-Extubation) technique. What is the PRIMARY advantage of INSURE over traditional intubation-ventilation for surfactant delivery?

• A INSURE delivers surfactant more evenly to both lungs than traditional intubation
• B INSURE avoids prolonged mechanical ventilation, reducing ventilator-induced lung injury and BPD incidence ✓
• C INSURE allows higher doses of surfactant to be administered safely
• D INSURE prevents infection risk associated with indwelling ETT

Explanation

The INSURE technique (brief intubation for surfactant administration followed by rapid extubation back to CPAP) is designed to deliver surfactant while avoiding the barotrauma and volutrauma associated with prolonged mechanical ventilation. Ventilator-induced lung injury (VILI) is a major contributor to bronchopulmonary dysplasia (BPD) in very preterm infants. INSURE reduces the duration of positive pressure ventilation and its associated lung injury, thereby decreasing the risk of BPD — the primary long-term respiratory complication of extreme prematurity. Surfactant distribution is similar regardless of technique.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.