OBJECTIVE: To study the effects of implementing a method for surfactant 
administration by transient intubation, INSURE (i.e. INtubation SURfactant 
Extubation) during nasal continuous positive airway pressure (nCPAP) for 
moderately preterm infants with respiratory distress syndrome (RDS).
STUDY DESIGN: A descriptive, retrospective, bi-center study in Stockholm, 
Sweden, comparing mechanical ventilation (MV) rates, surfactant use, treatment 
response and outcome of all inborn infants with gestational age 27 to 34 weeks 
and RDS, (n=420), during the 5-year periods before and after the introduction of 
the INSURE-strategy at one of the centers (Karolinska Huddinge) in 1998. The 
other center (Karolinska Solna) continued conventional surfactant therapy in 
conjunction with MV throughout the study.
RESULTS: Implementation of INSURE at Karolinska Huddinge reduced the number of 
infants requiring MV by 50% (P<0.01), resulted in earlier surfactant 
administration and increased overall surfactant use. INSURE-treatment improved 
oxygenation and the treatment response was sustained over time with only 17% of 
the infants requiring >1 dose of surfactant. At Karolinska Solna, the MV rates 
were unaltered between the first and second 5-year period.
CONCLUSION: Implementing a strategy of surfactant administration by transient 
intubation during nCPAP reduces the need for MV without adverse effects on 
outcome and may be an option to more effectively treat RDS, particularly in a 
care setting where transfer is necessary to provide MV.