• Gerhardus Francois Kirsten, Cheryl Linda Kirsten, Philippus Arnold Henning, Johan Smith, Sandi Lee Holgate, Adrie Bekker, Gugulabatembunamahlubi Tenjiwe Jabulile Kali, and Justin Harvey.
• Division of Neonatology, Tygerberg Children’s Hospital, Western Cape, South Africa. gfk@sun.ac.za
• Pediatrics. 2012 Apr 1;129(4):e952-9.

Background And ObjectiveNasal continuous positive airway pressure (NCPAP) plus intubation, surfactant, and extubation (InSurE) with the option of back-up ventilation for those infants for whom noninvasive ventilatory support failed resulted in a significant increase in survival in extremely low birth weight (ELBW) infants. The authors sought to determine the outcome of ELBW infants treated with NCPAP and InSurE in a neonatal high care ward with limited back-up ventilation.MethodsThree hundred eighteen inborn infants with birth weight 500-1000 g and gestational age ≥25 weeks who were admitted to the neonatal high care ward were included in this observational study. InSurE was administered to infants with respiratory distress syndrome on NCPAP who had severe in-drawing and recession, apneic spells, or an Fio(2) >0.4 within 1 hour of birth.ResultsTwo hundred twelve (68.6%) infants could be treated with NCPAP only and 97 (31.4%) required InSurE. Seventeen infants were admitted to the NICU; 90%, 87%, and 74.8% of the infants survived until day 3, 7, and discharge, respectively. Only 2 infants developed a pneumothorax and 2 had chronic lung disease. Seventy-nine percent of the infants of ≥750 g or >26 weeks' gestation survived to discharge compared with 56% and 60% of the infants of <750 g or ≤26 weeks' gestation, respectively. Maternal antenatal steroid administration contributed significantly to the survival of the infants (P = 0.0017, odds ratio 2.7, 95% confidence interval 1.44-5.07).ConclusionsThe use of NCPAP and InSurE in a neonatal high care ward with limited resources can improve the survival of ELBW infants. Maternal antenatal steroid administration contributed significantly to survival.

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