Surfactant for meconium aspiration syndrome in full term/near term infants

Objective. In light of the paucity of published data on the use of surfactant in full-term infants with respiratory failure due to meconium aspiration syndrome and respiratory distress syndrome, we report our experience with this therapy. Our goal was to explore possible justification for randomized controlled trials of surfactant treatment in similar patients at an earlier, less severe stage of the disease. Methods. Retrospective consecutive case series of 20 infants with severe meconium aspiration syndrome and 29 infants with severe respiratory distress syndrome who received bovine surfactant between March 1990 and December 1992 in three neonatal intensive care units in a regionalized setting. Outcome of treatment was assessed by comparing changes in several respiratory indices including the oxygenation index, between 4 and 6 hours and 1 and 3 hours before and after the first dose of surfactant. Differences were analyzed using analysis of variance for repeated measures, with treatment and time as co-variates. Results. In the meconium aspiration group the mean oxygenation index decreased from 36 ± 12 at 1 to 3 hours presurfactant to 24 ± 14 at 1 to 3 hours postsurfactant (P < .001). In the patients with respiratory distress syndrome the mean oxygenation index fell from 30 ± 17 at 1 to 3 hours presurfactant to 12 ± 6 at 1 to 3 hours postsurfactant (P = .0001). Three of 20 patients with meconium aspiration syndrome and 3 of 29 patients with respiratory distress syndrome received extracorporeal membrane oxygenation. Conclusions. Surfactant therapy in full-term infants with respiratory failure due to the meconium aspiration and respiratory distress syndromes is often effective in improving gas exchange. A randomized controlled trial of surfactant therapy at an earlier stage in the course of the illness should be performed.

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Steroids in full term infants with respiratory failure and pulmonary hypertension due to meconium aspiration syndrome

European Journal of Pediatrics ◽

10.1007/s004310000678 ◽

2001 ◽

Vol 160 (3) ◽

pp. 150-153 ◽

Cited By ~ 26

Author(s):

David Eustace da Costa ◽

Arun Kumar Nair ◽

Mangalore Govind Pai ◽

Saleh Mohammed Al Khusaiby

Keyword(s):

Pulmonary Hypertension ◽

Respiratory Failure ◽

Meconium Aspiration Syndrome ◽

Full Term ◽

Term Infants ◽

Meconium Aspiration

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Surfactant for meconium aspiration syndrome in full term infants

10.1002/14651858.cd002054 ◽

2000 ◽

Cited By ~ 38

Author(s):

RF Soll ◽

P Dargaville

Keyword(s):

Meconium Aspiration Syndrome ◽

Full Term ◽

Term Infants ◽

Meconium Aspiration

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Meconium Aspiration Syndrome

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.27.2.81 ◽

2008 ◽

Vol 27 (2) ◽

pp. 81-87 ◽

Cited By ~ 5

Author(s):

Jeanne Ray Wiedemann ◽

Andrea Saugstad ◽

Laura Barnes-Powell ◽

Karen Duran

Keyword(s):

Respiratory Distress ◽

Management Strategies ◽

Meconium Aspiration Syndrome ◽

Lung Compliance ◽

Term Infants ◽

Early Presentation ◽

Radiographic Findings ◽

Meconium Aspiration ◽

Near Term ◽

Meconium Stained Amniotic Fluid

Meconium aspiration syndrome (MAS) is one of the most common conditions associated with aspiration during the newborn period. MAS can be defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAF) with symptoms that cannot otherwise be explained. It can be characterized by early onset of respiratory distress in term and near-term infants delivered through MSAF. Early presentation includes respiratory symptoms such as respiratory distress, poor lung compliance, hypoxemia, and radiographic findings of hyperinflation and patchy opacifications. This article discusses the pathophysiology of MAS, historical and current prevention strategies, current management strategies, and prognoses for infants born through MSAF.

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Wilson-Mikity or Meconium Aspiration Syndrome?

PEDIATRICS ◽

10.1542/peds.51.2.311 ◽

1973 ◽

Vol 51 (2) ◽

pp. 311-311

Author(s):

Morton L. Cohen

Keyword(s):

Respiratory Distress ◽

Meconium Aspiration Syndrome ◽

Full Term ◽

Term Neonate ◽

Meconium Aspiration ◽

Chest Film ◽

Classic Case ◽

The Third

In reporting the third case of Wilson-Mikity syndrome in a full-term neonate, Drs. Keidel and Feingold1 appear instead to have described a classic case of meconium aspiration syndrome. Their patient, delivered with difficulty at 41 weeks' gestation, aspirated meconium at the time of delivery and was severely asphyxiated at birth. Respiratory distress developed after resuscitation and the baby was noted to have "diffuse granularity of both lung fields and hyperinflation indicating meconium aspiration." Later, when the chest film showed "hyperexpanded lungs with depressed diaphragms and cyst-like foci alternating with coarse infiltrates" their diagnostic impression apparently changed to Mikity-Wilson syndrome.

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Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants

Medicine ◽

10.1097/01.md.0000473677.19790.44 ◽

2015 ◽

Vol 94 (45) ◽

pp. e9044

Keyword(s):

Necrotizing Enterocolitis ◽

Broad Spectrum ◽

Full Term ◽

Stage Ii ◽

Broad Spectrum Antibiotic ◽

Term Infants ◽

Near Term

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Hydrocortisone Improves Oxygenation Index and Systolic Blood Pressure in Term Infants With Persistent Pulmonary Hypertension

Clinical Medicine Insights Pediatrics ◽

10.1177/1179556519888918 ◽

2019 ◽

Vol 13 ◽

pp. 117955651988891 ◽

Cited By ~ 2

Author(s):

Mahdi Alsaleem ◽

Aysha Malik ◽

Satyan Lakshminrusimha ◽

Vasantha HS Kumar

Keyword(s):

Blood Pressure ◽

Pulmonary Hypertension ◽

Systolic Blood Pressure ◽

Animal Studies ◽

Oxygenation Index ◽

Retrospective Chart Review ◽

Meconium Aspiration Syndrome ◽

Persistent Pulmonary Hypertension ◽

Term Infants ◽

Near Term

Persistent pulmonary hypertension of the newborn (PPHN) is an essential cause for hypoxic respiratory failure with significant morbidity and mortality in term and near-term neonates. Hydrocortisone has been shown to decrease oxygen dependency and pulmonary hypertension in neonates with meconium aspiration syndrome and animal studies, respectively. We hypothesize that hydrocortisone will improve oxygenation in term and near-term infants with pulmonary hypertension. We performed a retrospective chart review of all infant with PPHN who received intravenous hydrocortisone therapy as a rescue for severe PPHN. Clinical response was objectively measured using, oxygenation index (OI), PaO2/FiO2 ratio, and inotrope score before, during, and after the hydrocortisone course. We found that hydrocortisone administration resulted in significant improvement of systolic blood pressure, OI, and PaO2/FiO2. In conclusion, hydrocortisone increased systolic blood pressure and improved oxygenation in term and near-term infants with persistent pulmonary hypertension. Prospective randomized trials are required to evaluate these findings further.

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Broad-spectrum Antibiotic Plus Metronidazole May Not Prevent the Deterioration of Necrotizing Enterocolitis From Stage II to III in Full-term and Near-term Infants

Medicine ◽

10.1097/md.0000000000001862 ◽

2015 ◽

Vol 94 (42) ◽

pp. e1862 ◽

Cited By ~ 5

Author(s):

Li-Juan Luo ◽

Xin Li ◽

Kai-Di Yang ◽

Jiang-Yi Lu ◽

Lu-Quan Li

Keyword(s):

Necrotizing Enterocolitis ◽

Broad Spectrum ◽

Full Term ◽

Stage Ii ◽

Broad Spectrum Antibiotic ◽

Term Infants ◽

Near Term

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Advances in the Management of Meconium Aspiration Syndrome

International Journal of Pediatrics ◽

10.1155/2012/359571 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 36

Author(s):

Kamala Swarnam ◽

Amuchou S. Soraisham ◽

Sindhu Sivanandan

Keyword(s):

Nitric Oxide ◽

Meconium Aspiration Syndrome ◽

Term Infants ◽

Severe Respiratory Distress ◽

Meconium Aspiration ◽

Common Cause ◽

Acute Airway Obstruction ◽

Life Threatening ◽

Surfactant Dysfunction ◽

Over Time

Meconium aspiration syndrome (MAS) is a common cause of severe respiratory distress in term infants, with an associated highly variable morbidity and mortality. MAS results from aspiration of meconium during intrauterine gasping or during the first few breaths. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis with release of vasoconstrictive and inflammatory mediators, and persistent pulmonary hypertension of newborn (PPHN). This disorder can be life threatening, often complicated by respiratory failure, pulmonary air leaks, and PPHN. Approaches to the prevention of MAS have changed over time with collaboration between obstetricians and pediatricians forming the foundations for care. The use of surfactant and inhaled nitric oxide (iNO) has led to the decreased mortality and the need for extracorporeal membrane oxygenation (ECMO) use. In this paper, we review the current understanding of the pathophysiology and management of MAS.

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Surfactant Replacement Therapy for Meconium Aspiration Syndrome

PEDIATRICS ◽

10.1542/peds.97.1.48 ◽

1996 ◽

Vol 97 (1) ◽

pp. 48-52 ◽

Cited By ~ 1

Author(s):

Richard D. Findlay ◽

H. William Taeusch ◽

Frans J. Walther

Keyword(s):

Mechanical Ventilation ◽

Replacement Therapy ◽

Meconium Aspiration Syndrome ◽

Control Group ◽

Study Group ◽

Term Infants ◽

Meconium Aspiration ◽

Air Leaks ◽

Surfactant Replacement Therapy ◽

Pulmonary Morbidity

Objective. The pathophysiology of meconium aspiration syndrome (MAS) is related not only to mechanical obstruction of the airways and chemical injury to the respiratory epithelium but also to surfactant inactivation by meconium. A randomized, controlled study was performed to determine whether high-dose surfactant therapy improves the pulmonary morbidity of term infants ventilated for MAS. Methods. Forty term infants receiving mechanical ventilation for MAS were enrolled in this trial, in which the infants in the study group (n = 20) received up to four doses of 150 mg (6 mL)/kg beractant (Survanta), instilled every 6 hours by continuous infusion for 20 minutes via a side hole endotracheal tube adapter, and the infants in the control group (n = 20) received 6 mL/kg air placebo. Results. Mean arterial-to-alveolar Po2 ratio values increased from 0.09 to 0.11 at 1 and 6 hours with a concomitant slight decrease in oxygenation index values from 23.7 to 19.7 at 1 hour and 20.7 at 6 hours after the first dose of surfactant. Oxygenation improved cumulatively after the second and third dose of surfactant, with mean arterial-to-alveolar Po2 ratios and oxygenation indices of 0.18 and 12.1 at 6 hours after the second dose of surfactant and 0.31 and 5.9 at 6 hours after the third dose of surfactant, eliminating the need for a fourth dose in any infant in the study group. After three doses of surfactant, persistent pulmonary hypertension had resolved in all but one of the infants in the study group versus none of the infants in the control group. No air leaks developed in any of the 20 infants in the study group after surfactant therapy, and only 1 infant required extracorporeal membrane oxygenation. Air leaks developed in 5 of the 20 infants in the control group, and 6 underwent extracorporeal poreal membrane oxygenation. The duration of mechanical ventilation, oxygen therapy, and admission was significantly shorter in the surfactant group than in the control group. Conclusion. Surfactant replacement therapy, if started within 6 hours after birth, improves oxygenation and reduces the incidence of air leaks, severity of pulmonary morbidity, and hospitalization time of term infants with MAS.

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