Abstract
Abstract
This study is based on clinical data from a retrospective series of 54 infants with meconium aspiration syndrome treated with porcine surfactant at a median age of 14 h (range 1–176 h). Median arterial/alveolar oxygen tension ratio (a/APO2 ratio) before treatment was 0.08 (range 0.02–0.23) and oxygenation index 25 (range 6–110). After treatment with surfactant at an initial dose of 50–200 mg/kg there was a modest but statistically significant increase in a/APO2 ratio associated with a reduction of oxygenation index. Ten (18%) babies showed a 3–4 fold increase in a/APO2 ratio within 1–2 h of treatment. Twenty-four (44%) babies showed little or no response by 1–2 h with the remaining infants showing modest improvement in oxygenation. One third of babies required repeated doses of surfactant. Twenty-eight day survival was 81%, with two babies requiring extracorporeal membrane oxygenation.
Conclusion
Natural surfactant treatment of severe meconium aspiration may prove to be a useful intervention and randomised controlled clinical trials should be undertaken.
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Abbreviations
- a/APO 2 :
-
arterial/alveolar oxygen tension ratio
- ECMO :
-
extracorporeal membrane oxygenation
- FiO 2 :
-
fractional inspired oxygen
- MAP :
-
mean airway pressure
- OI :
-
oxygenation index
- PIP :
-
peak inspiratory pressure
References
Auten R, Notter RH, Kendig JW, Davis JM, Shapiro DL (1991) Surfactant treatment of full-term newborns with respiratory failure. Pediatrics 87: 101–107
Collaborative European Multicenter Study Group (1988) Surfactant replacement therapy for severe neonatal respiratory distress syndrome: an international randomized clinical trial. Pediatrics 82: 683–691
Glick PL, Leach CL, Besner GE, Egan EA, Morin FC, Malanowska-Kantoch A, Robinson LK, Brody A, Lele AS, McDonnell M, Holm B, Rodgers BT, Msall ME, Courey NG, Karp MP, Allen JE, Jewett Jr. TC, Cooney DR (1992) Pathophysiology of congenital diaphragmatic hernia III: exogenous surfactant therapy of the high-risk neonate with CDH. J Pediatr Surg 27: 866–869
Halliday HL, McCord FB, McClure BG, Reid MMcC (1989). Acute effects of instillation of surfactant in severe respiratory distress syndrome. Arch Dis Child 64: 13–16
Hofkosh D, Thompson AE, Nozza RJ, Kemp SS, Bowen A, Feldman HM (1991) Ten years of extracorporeal membrane oxygenation: neurodevelopmental outcome. Pediatrics 87: 549–555
Jobe AH (1993) Pulmonary surfactant therapy. N Engl J Med 328: 861–868
Khammash H, Pearlman M, Wojtulewicz J, Dunn M (1993) Surfactant therapy in full-term neonates with severe respiratory failure. Pediatrics 92: 135–139
Lotze A, Knight GR, Martin GR, Bulas DI, Hull WM, O'Donnell RM, Whitsett JA, Short BL (1993) Improved pulmonary outcome after exogenous surfactant therapy for respiratory failure in term infants requiring ECMO. J Pediatr 122: 261–268
Moses D, Holm BA, Spitale P, Liu M, Enhorning G (1991) Inhibition of pulmonary surfactant by meconium. Am J Obstet Gynecol 164: 477–481
Ohama Y, Itakura Y, Koyama W, Eguchi H, Ogawa Y (1994) Effect of surfactant lavage in a rabbit model of meconium aspiration syndrome. Acta Paediatr Jpn 36: 236–238
Pandit PB, Dunn MS, Colucci EA (1995) Surfactant therapy in neonates with respiratory deterioration due to pulmonary hemorrhage. Pediatrics 95: 32–36
Pandit PB, Dunn MS, Kelly EN, Pearlman M (1995) Surfactant replacement in neonates with early chronic lung disease. Pediatrics 95: 851–854
Papile L-A, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1500 gm. J Pediatr 92: 529–534
Paranka MS, Walsh WF, Stancombe BR (1992) Surfactant lavage in a piglet model of meconium aspiration syndrome. Pediatr Res 31: 625–628
Sun B, Curstedt T, Robertson B (1993) Surfactant inhibition in experimental meconium aspiration. Acta Paediatr 82: 182–189
Sun B, Curstedt T, Song G-W, Robertson B (1993) Surfactant improves lung function and morphology in newborn rabbits with meconium aspiration. Biol Neonate 63: 96–104
Sun B, Herting E, Curstedt T, Robertson B (1994) Exogenous surfactant improves lung compliance and oxygenation in adult rats with meconium aspiration. J Appl Physiol 77: 1961–1971
Tyler DC, Murphy J, Cheney FW (1978) Mechanical and chemical damage to lung tissue caused by meconium aspiration. Pediatrics 62: 454–459
Wiseman LR, Bryson HM (1994) Porcine-derived lung surfactant. A review of the therapeutic efficacy and clinical tolerability of a natural surfactant preparation (CurosurfR) in neonatal respiratory distress syndrome. Drugs 48: 386–403
Wiswell TE, Peabody SS, Davis JM, Slayter MV, Bent RC, Merritt TA (1994) Surfactant therapy and high-frequency jet ventilation in the management of a piglet model of the meconium aspiration syndrome. Pediatr Res 36: 494–500
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Halliday, H.L., Speer, C.P. & Robertson, B. Treatment of severe meconium aspiration syndrome with porcine surfactant. Eur J Pediatr 155, 1047–1051 (1996). https://doi.org/10.1007/BF02532529
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DOI: https://doi.org/10.1007/BF02532529