90 Surfactant Lung Lavage and Inhaled Nitric Oxide in The Treatment of Meconium Aspiration Syndrome 2- Influence on Duration of Mechanical Ventilation, Inhalation of Nitric Oxide, Hospitalization, and Complications

Abstract

The most severe clinical problem which coexist with the meconium aspiration syndrome/MAS/is persistent pulmonary hypertension/PPHN/.The aim of our study was to evaluate the efficacy of treatment of MAS for selected clinical parameters. The designed therapeutic approach consisted of surfactant lung lavage/SLL/and surfactant instillation together with Nitric Oxide inhalation/iNO/. The study population was randomized into two groups: group A/n= 7/treated with SLL, surfactant instillation and iNO, and group B/n= 6/treated with surfactant instillation and iNO. Criteria for inclusion: maturity >35 weeks of gestation, time after delivery < 24hours, presence of fluid containing meconium below vocal cords, respiratory insufficiency demanding mechanical ventilation/Fi0240%/, radiological changes, and echocardiographic features of pulmonary hypertension.Method: SLL was performed with natural surfactant solution (Survanta, Ross Abbott Laboratories) in concentration of 5mg of phospholipids/1 ml 0,9% NaCl, a dose of 15ml of solution per 1 kg. A dose of 100 mg of Surfactant per 1 kg was applied. The initial NO dose was 20 ppm. The parameters analyzed: duration of IMV, duration of iNO, duration of hospitalization, air leaks and deaths.Results: (mean value ± b SD). Duration of IMV: GROUP A- 6,6± b 2,5days vs. GROUP B- 7,3± b 1,7days (NS). Duration of iNO: GROUP A- 2,9 ± b1,5days vs. GROUP B- 3,5 ± b1,3days (NS). Duration of hospitalization: GROUP A-16,4 ± b5,4 days vs. GROUP B- 19, ± b2,9 days (NS). Air leaks: GROUP A- 0 vs. GROUP B- 2 (NS). Deaths: GROUP A- 0; GROUP B- 2 (NS).Conclusions: The associated treatment of SLL with natural surfactant solution together with iNO in the therapy of severe meconium aspiration syndrome with persistent pulmonary hypertension does not have a significant influence on the reduction of duration of IMV, iNO and the hospitalization time and on the reduction of occurrence of complications and deaths.