Explain the INSURE approach to surfactant therapy and its intended goal in the care of preterm infants with RDS.

• A. Intubate briefly to deliver surfactant, then extubate to CPAP once stable to minimize lung injury from mechanical ventilation.
• B. Deliver surfactant via IV infusion and avoid intubation.
• C. Administer surfactant through nebulization only.
• D. Use surfactant as a last resort after maximal ventilation fails.

Answer: (B)

The main idea is that surfactant therapy is delivered directly into the lungs through a brief endotracheal tube, then the infant is kept on noninvasive support. INSURE stands for INtubate, SURfactant, Extubate to CPAP. A small amount of surfactant is given via the endotracheal tube to quickly coat the alveoli and improve lung compliance, and then the tube is removed so the infant stays on continuous positive airway pressure (CPAP). The goal is to rapidly correct surfactant deficiency and improve oxygenation while avoiding prolonged mechanical ventilation, which can contribute to lung injury and complications like bronchopulmonary dysplasia. Delivering surfactant intravenously isn’t effective because the drug needs to reach the alveoli directly, and INSURE emphasizes the airway delivery with prompt extubation to noninvasive support.