The INSURE technique is aimed to reduce ventilation induced lung injury (VILI) but is also associated with repeated doses of surfactant and initiation of CPAP (7). But there is significant variation in peri-extubation practices and approximately 50% of extremely premature infants fail extubation (11). Gupta et al proposed extubation calculator to assess the readiness based on gestational age, age at extubation, pH, FiO2, weight at extubation and peak respiratory severity score in first 6 hours (11). But a major limitation was that the institute did not practice INSURE at that point. Eugenio et al found PROM and GA as predictive factors for successful extubation (12). No studies have so far used pulmonary function parameters to assess extubation readiness
Inclusion Criteria
- All infants ≤ 35weeks gestational age admitted to the Neonatal ICU at Tufts Medical Center with respiratory distress syndrome requiring Curosurf surfactant administration.
Exclusion Criteria
- Known congenital pulmonary/ cardiac abnormalities or abdominal wall defects in the immediate neonatal period.
Study Requirements
RFM will be attached to all infants born ≤ 35 weeks gestational age needing respiratory support including mechanical ventilation/ CPAP/ intubation. If infant remains intubated, we will continue to measure data using RFM and RIP equipment. RIP ribcage and abdominal elastic bands will be applied with in 30 minutes prior to surfactant administration when possible and will remain on post surfactant administration for 4hours. Pulmonary function testing will be the intervention for our study. The NICU team will continue clinical management of infant as per the unit protocol and without analyzing the data on RIP and RFM. We shall collect data with in 30 minutes baseline pre surfactant and then hourly up to 4 hours post surfactant administration. The remainder of the care in Delivery Room and NICU will be as per unit protocol and NRP. We will extract demographic data from the electronic medical charts which will also include maternal admission diagnosis, prenatal screens, mode of delivery, administration of antenatal steroids, antibiotics, antihypertensive agents, duration of rupture of membranes, COVID status, maternal fever and chorioamnionitis.
