• Gina Ancora, Eugenia Maranella, Sara Grandi, Luca Pierantoni, Mariangela Guglielmi, and Giacomo Faldella.
• Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy. gina.ancora@libero.it
• Acta Paediatr. 2010 Dec 1; 99 (12): 1807-11.

Aim  Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV).Methods  Chart data of infants with a birth weight <1500 gr or GA <32weeks undergoing InSurE in the period 2002-2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO(2) >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure.ResultsSix of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001).Conclusions  BiPAP reduced the need for MV after InSurE failure.© 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

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