Saline lavage with substitution of bovine surfactant in term neonates with meconium aspiration syndrome (MAS) transferred for extracorporeal membrane oxygenation (ECMO): a pilot study

Abstract

BACKGROUND: Meconium aspiration syndrome (MAS) is still a condition associated with a high mortality, and many patients require extracorporeal membrane oxygenation (ECMO) as rescue therapy. Beneficial effects of surfactant and perflubron lavage have been reported. However, pure surfactant supplementation has not been proven to be beneficial in the most severe forms of MAS. This study was performed to demonstrate an improvement in oxygenation in neonates transferred for ECMO and fulfilling ECMO criteria with a saline lavage and surfactant resupplementation. METHODS: Twelve newborns with MAS [gestational age 36-40 weeks, mean birth weight 3200 g, age 4-16 h, oxygenation index (OI) > 40] transferred for ECMO therapy were treated with saline lavage (5-10 cm3/kg body weight, as long as green colored retrieval was observed) and resupplementation with bovine surfactant (Alveofact, Boehringer, Ingelheim, Germany). The OI at admission and 3 h after this procedure was compared using the t-test for paired samples. ECMO was available as rescue therapy at all times. RESULTS: The OI decreased from 49.4 (SD +/- 13.3) to 27.4 (SD +/- 7.3), P < 0.01. The decrease was sustained in nine patients, three patients required ECMO and all patients survived. CONCLUSIONS: As MAS is a condition with parenchymal damage, pulmonary hypertension and obstructive airway disease, no simple causative therapy is possible. Surfactant application after removal of meconium by extensive lavage is feasible as long as 16 h after birth even in infants considered for ECMO therapy; it might reduce the necessity of ECMO.

Figure 1

Oxygenation index (mean airway pressure×FiO₂ ×100/paO₂) beforeand after saline lavage and surfactant resupplementation in 12 neonates (mean 75th and 97th percentile).

Figure 2

Chest X-ray in one patient at admission, demonstrating features of meconium aspiration.

Figure 3

Chest X-ray 2 h after lavage/surfactant procedure in the same patient as in Fig 1, showing clearing of infiltrate.