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Innovative neonatal ventilation and meconium aspiration syndrome
Vinod K Bhutani1, Ranjit Chima, Emidio M Sivieri
1Newborn Pediatrics, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, USA. vbhut@pahosp.com
Insights
A system-based approach effectively minimized adverse outcomes in neonates with meconium aspiration syndrome (MAS). This strategy reduced the need for advanced respiratory support, including high-frequency oscillatory ventilation (HFOV) and extracorporeal membrane oxygenation (ECMO).
Area of Science:
- Neonatal respiratory failure
- Perinatal care
- Meconium aspiration syndrome (MAS) management
Background:
- Respiratory failure is a leading cause of neonatal mortality.
- Meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia/sepsis contribute to hypoxemic respiratory failure.
- Advanced treatments like HFOV, surfactant, and iNO have emerged, alongside ECMO, to improve survival.
Purpose of the Study:
- To outline a system-based strategy for prenatal, natal, and postnatal management of infants exposed to meconium-stained amniotic fluid (MSAF).
- To minimize adverse outcomes and reduce the need for innovative ventilatory support in neonates with MSAF.
- To evaluate the impact of this comprehensive approach at a regional Level III perinatal center.
Main Methods:
- Retrospective analysis of data from Pennsylvania Hospital over a six-year period (1995-2000).
- Tracking incidence of MSAF, MAS, and need for ventilatory support, including innovative methods.
- Implementation and assessment of a system-based management strategy.
Main Results:
- 14.5% of live births were exposed to MSAF.
- 4.6% of MSAF infants developed MAS.
- Only 0.17% of all live births required ventilatory support for MAS, with 0.035% needing innovative support; no deaths or ECMO cases occurred.
Conclusions:
- A system-based management strategy significantly reduces adverse outcomes in neonates with MSAF.
- This approach effectively minimizes the need for advanced respiratory interventions like HFOV and ECMO.
- The strategy demonstrates successful prevention and management of MAS-related complications at a regional perinatal center.
Abstract:
Respiratory failure remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia/sepsis have a potential for increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options previously limited to inotropic support, conventional ventilatory management, respiratory alkalosis, paralysis and intravenousvasodilators have been replaced by high-frequency oscillatory ventilation (HFOV), surfactant, and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting surfactant deficiency or inactivation may contribute to neonatal respiratory failure exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. In this article, the authors place in context of a system-based strategy the prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized, and the least number of babies require innovative ventilatory support. At Pennsylvania Hospital, over a six-year period (1995 to 2000), 14.5% (3370/23,175 of live births babies were delivered with MSAF. These data show that 4.6% (155/3370) of babies with MSAF sustained MAS. Overall, 26% (40/155) of babies with MAS needed ventilatory support (or 0.17% of all live-births); of these only 20% (8/40 or 0.035% of live births) needed innovative ventilatory support. None died or needed ECMO. These data describe the impact of a system-based approach to prevent and manage adverse outcomes related to MSAF at regional Level III perinatal center.