Treatment Of Meconium Aspiration Syndrome Research Articles

Meconium aspiration syndrome treatment – New approaches using old drugs

Presently, modern medicine does not offer any disease-modifying treatment for meconium aspiration syndrome (MAS). Several medications with already established safety profiles when employed for similar or other conditions could be useful for MAS treatment. N-Acetylcysteine and DNAse have the capability to reduce viscosity and thickness of meconium by breaking disulfide bonds and slicing DNA, respectively. N-Acetylcysteine, antiprotease drugs, or low pH buffer solutions may have the capability to neutralize meconium's digestive enzymes responsible for lung damage in patients with MAS. All these compounds have great potential to reduce meconium's pathogenic properties which in turn could alleviate MAS severity.

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

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.

Treatment of severe meconium aspiration syndrome with dilute surfactant lavage.

Despite the development of new adjuvant therapies, meconium aspiration syndrome (MAS) remains a serious respiratory disorder in neonates. Surfactant inactivation by meconium can be overcome by use of exogenous surfactant. This study sought to assess the efficacy and safety of dilute surfactant lavage at 2 different concentrations to treat severe MAS. We retrospectively reviewed the charts of all term infants with a diagnosis of MAS who had an oxygenation index (OI) > 20 during a 2-year period. Tracheobronchial lavage was performed with a dilute surfactant suspension (5 mg/mL or 10 mg/mL) to reach a total dose of 60 to 70 mg/kg of phospholipid, administered in aliquots of 2 mL. The records of 22 patients were reviewed, of whom 12 had undergone lavage. These patients were subdivided into low-concentration (surfactant concentration, 5 mg/mL; n = 6) and high-concentration (surfactant concentration, 10 mg/mL; n = 6) subgroups. There were no significant differences in demographic characteristics between these 2 subgroups. The lavaged infants had a significantly higher arterial partial pressure of oxygen (PaO(2)) 24 hours after lavage than the infants without lavage (178.3 mm Hg vs 80.6 mm Hg, p < 0.05). The incidence of pneumothorax (1/12 vs 7/10, p < 0.05) and requirement for inhaled nitric oxide (5/12 vs 9/10, p < 0.05) were significantly lower in the lavaged group. All infants tolerated the procedure well except for 2 with transient complications. There were no significant differences in duration of lavage, response and complications between subgroups lavaged at low and high surfactant concentration. Early lavage with dilute surfactant solution at a phospholipid concentration of either 5 mg/mL or 10 mg/mL is effective for the treatment of severe MAS. Further large-scale, prospective, randomized, controlled trials are necessary to establish the optimal dose, concentration, surfactant product, and instillation method of this treatment before it can be recommended for routine use.

Prevention and management of meconium aspiration syndrome

The appearance of meconium in the liquor during labour has caused concerns to birth attendants at least since the time of Aristotle. He noted that infants born through meconium stained liquor were often 'sleepy'. The reasons for the passage of meconium in utero, its significance and implications, the management of the labour and the newborn baby have been debated for many years. A combined intrapartum and postpartum management strategy has evolved since the early 1970s and in various forms is the accepted approach in the 1990s. Most of the current research is aimed at understanding the effects of meconium in the lung of the newborn and the best ways of preventing or ameliorating its consequences. This paper will concentrate on the mechanisms of lung injury and the management principles for prevention and treatment of meconium aspiration syndrome (MAS), the major pulmonary complication of meconium stained liquor.