OBJECTIVE: To evaluate the clinical effectiveness and safety of 
intubation-surfactant-extubation (INSURE) method in the treatment of neonatal 
respiratory distress syndrome (NRDS), and to investigate its possible 
mechanisms.
METHODS: Sixty-four premature infants, who were admitted for NRDS and treated 
with pulmonary surfactant from March 2010 to March 2012, were enrolled in the 
study. They were randomly divided into INSURE (n=32) and conventional mechanical 
ventilation (CMV) groups (n=32). The two groups were compared in terms of 
respiratory function, ventilation time, duration of oxygen therapy, 
complications, and prognosis, as well as expression of interleukin-10 (IL-10), 
tumor necrosis factor-α (TNF-α) and serum ferritin (SF).
RESULTS: Oxygenation index in the INSURE group was significantly higher than in 
the CMV group at 48 hours after treatment (P<0.05). Compared with the CMV group, 
the INSURE group showed significantly lower incidence of ventilator-associated 
pneumonia (VAP) and significantly shorter duration of oxygen therapy (P<0.05 for 
all comparisons). There were no significant differences in ventilation time and 
the incidence of pneumothorax, intracranial hemorrhage, necrotizing 
enteroolitis, bronchopulmonary dysplasia, and pneumorrhagia between the two 
groups (P>0.05). The levels of TNF-α and SF were significantly lower in the 
INSURE group than in the CMV group at 6, 24, 48, and 72 hours after treatment 
(P<0.05), while the level of IL-10 was significantly higher in the INSURE group 
than in the CMV group (P<0.05).
CONCLUSIONS: INSURE method can improve the oxygenation function of the lung, 
decrease the incidence of VAP and shorten the duration of oxygen therapy in 
neonates with NRDS, which is probably due to the fact that this method can 
reduce the production of TNF-α and SF and inhibit the decrease of IL-10.