[An effectiveness of surfactant lung lavage (SLL) in meconium aspiration syndrome (MAS)]

The aim of our study was to evaluate an effect of surfactant lung lavage (SLL) in severe meconium aspiration syndrome (MAS).

22 neonates were divided into 2 groups: group A treated with SLL (n = 11) and group B--historic control (n = 11). The criteria for entry into the study were as follows: stain amniotic fluid, meconium below vocal cords, gestational age > 35 wks, time after delivery < 6 h, clinical manifestation of severe respiratory insufficiency, need for mechanical ventilation (FiO2 > 0.4) and pathological chest X-ray.

SLL was done between 1. and 6. hours of life with natural surfactant (Survanta) in concentration 5 mg of phospholipids/1 ml 0.9% NaCl (15 ml of solution per kg). Following data were analyzed IO, PaO2, FiO2 (before treatment and 1, 2, 4, 48 hours after), duration of hospitalization, death rate.

The mean value in group A (+/- SD) before SLL were as follow: IO 19.0 (12.4). PaO2--51.4 mmHg (14.1). FiO2--0.8 (0.3); after 1 hour: IO--13.7 (9.4). PaO2--63.8 mmHg (16.8). FiO2--0.7 (0.3). After 48 hours: IO--4.2 (2.4). PaO2--60.5 mmHg (7.2). FiO2--0.38 (0.1); duration of IMV--5.6 days (4.1); duration of hospitalization--20.5 days (8.8). No deaths occurred. In group B in 1st hour of life mean value (+/- SD) were as follows: IO 22.4 (14.5). PaO2--47.7 mmHg (12.1). FiO2--0.8 (10.3); after 1 hour: IO--21.5 (17.8). PaO2--52.2 mmHg (24.1). FiO2--0.7 (0.3); after 48 hours: IO--7.6 (5.8). PaO2--57.7 (16.4) mmHg. FiO2--0.5 (0.3); duration of IMV--5.9 days (4.8); duration of hospitalization--22.4 days (11.3). One newborn died in group B.

Our pilot SLL study showed the benefit of this procedure in newborns with severe MAS. In treating MAS, SLL allows to achieve lower IO and higher of PaO2 after 1 hour, shorten the time of mechanical ventilation and hospitalization.