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Current strategy for management of meconium aspiration syndrome
1Department of Pediatrics, Saitams Medical Center, Saitama Medical School, Japan. yjogawa@saitama-med.ac.jp
Abstract:
Meconium aspiration syndrome (MAS) is characterized by the atelectasis due to the complete airway obstruction, emphysema and air leak syndrome resulted from the partial obstruction of airway, chemical pneumonitis, and surfactant dysfunction. As far as meconium is present in the airway, exogenous surfactant will be inactivated rather quickly even given as multiple doses. MAS can easily develop persistent pulmonary hypertension of the newborn. Therefore, the removal of meconium from the airway rather than the surfactant replacement therapy should be the cardinal step for the treatment of MAS. Our previous studies revealed that the removal of meconium from airway by the tracheobronchial lavage with diluted surfactant solution, 100 mg/10 mL/Kg of Surfactant-TA, resulted in the recovery of both blood gas values and lung compliance to the normal range. Thus, the current strategies of management of MAS are the selective intubation with toileting only on infants with severe distress at birth, and the early airway lavage with diluted surfactant solution, followed by high frequency oscillatory ventilation, which may prevent the further injuries in the fragile neonatal lung.
Insights
Meconium aspiration syndrome (MAS) treatment prioritizes airway meconium removal over surfactant therapy. Tracheobronchial lavage with diluted surfactant effectively restores lung function in newborns with MAS.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Meconium aspiration syndrome (MAS) causes severe respiratory distress in newborns.
- MAS complications include atelectasis, emphysema, air leaks, pneumonitis, and surfactant dysfunction.
- Persistent pulmonary hypertension of the newborn (PPHN) is a common MAS complication.
Purpose of the Study:
- To highlight the importance of meconium removal in MAS management.
- To present tracheobronchial lavage with diluted surfactant as an effective treatment.
- To outline current strategies for managing MAS.
Main Methods:
- Selective intubation and airway toileting for infants with severe distress.
- Early tracheobronchial lavage using diluted Surfactant-TA (100 mg/10 mL/Kg).
- High-frequency oscillatory ventilation (HFOV) post-lavage.
Main Results:
- Tracheobronchial lavage effectively removed meconium from the airway.
- Lavage treatment led to recovery of normal blood gas values.
- Lung compliance significantly improved following the procedure.
Conclusions:
- Airway meconium clearance is the primary treatment for MAS.
- Diluted surfactant lavage is a crucial component of MAS management.
- Early intervention with lavage and HFOV can prevent neonatal lung injury.