Risk Factors for INtubation-SURfactant-Extubation Failure in Infants With Neonatal Respiratory Distress Syndrome

•INSURE strategy cannot be universally applied to all preterm neonates.•Specific predictors with an unsuccessful INSURE strategy were identified.•Infants in the INSURE failure group had higher mortality.•Keeping high-risk preterms with one or several predictors intubated and treated with mechanical ventilation after surfactant may prevent a re-intubation procedure and reduce mortality. To identify clinical characteristics predictive of failure or success of the INtubation-SURfactant-Extubation (INSURE) strategy, to distinguish infants who could be managed using this strategy to prevent mechanical ventilation (MV). Infants with a gestational age