OBJECTIVES: Our aim was to evaluate whether single and multiple 
intubation-surfactant-extubation (INSURE) procedures have similar effects on the 
need of mechanical ventilation (MV) and occurrence of bronchopulmonary dysplasia 
(BPD) in extremely preterm infants.
METHODS: We studied infants of <30 weeks of gestation with respiratory distress 
syndrome (RDS) who were treated with single (FiO(2)>0.30 without need of MV) or 
multiple (FiO(2)>0.40 without need of MV) INSURE procedures.
RESULTS: Seventy-five infants were studied: 53 (71%) received single INSURE and 
22 (29%) received multiple INSURE procedures. Infants in the single and multiple 
groups had similar rates of need of MV (15 vs. 23%) and occurrence of BPD (9 vs. 
9%), although the latter were more immature and affected by more severe RDS 
(higher FiO(2), lower a/ApO(2), and pO(2)/FiO(2)) than the former.
CONCLUSIONS: Single and multiple INSURE procedures were followed by similar 
respiratory outcome in a cohort of extremely preterm infants. Further studies 
are warranted to evaluate whether the multiple INSURE strategy enhances the 
success rate of INSURE in preventing the need of MV and the occurrence of BPD.