BACKGROUND AND OBJECTIVE: Nasal 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.
METHODS: Three 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.
RESULTS: Two 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).
CONCLUSIONS: The 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.