scholarly journals Advances in the Management of Meconium Aspiration Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
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.

Surfactant Therapy in Full-term Neonates With Severe Respiratory Failure

PEDIATRICS ◽  
1993 ◽  
Vol 92 (1) ◽  
pp. 135-139
Author(s):  
Hatem Khammash ◽  
Max Perlman ◽  
Julian Wojtulewicz ◽  
Michael Dunn
Keyword(s):  
Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Oxygenation Index ◽  
Meconium Aspiration Syndrome ◽  
Full Term ◽  
Surfactant Therapy ◽  
Term Infants ◽  
Meconium Aspiration

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.

scholarly journals EFFECT OF NITRIC OXIDE IN MECONIUM ASPIRATION SYNDROME AFTER TREATMENT WITH SURFACTANT. † 2064

1996 ◽  
Vol 39 ◽  
pp. 347-347
Author(s):  
Khodavar Rais-Bahrami ◽  
Oswaldo Rivera ◽  
Carlos A Velarde ◽  
Winslow R Seale ◽  
Billie L Short
Keyword(s):  
Nitric Oxide ◽  
Meconium Aspiration Syndrome ◽  
Meconium Aspiration

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

2001 ◽  
Vol 160 (3) ◽  
pp. 150-153 ◽  
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

Surfactant Replacement Therapy for Meconium Aspiration Syndrome

PEDIATRICS ◽  
1996 ◽  
Vol 97 (1) ◽  
pp. 48-52 ◽  
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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