Contemporary treatment options for meconium aspiration syndrome

Abstract

The presence of meconium in the respiratory tract causes atelectasis, hypoxemia, hypercapnia, persistent pulmonary hypertension, inflammatory changes, and surfactant inactivation. Prevention is the most important factor in the management of meconium aspiration syndrome and it includes both prenatal and postnatal care. Prenatal procedures include constant fetal heart rate monitoring during labor, examination of acid-base equilibrium in the capillary blood from the fetal scalp, and eventually amnioinfusion. Amnioinfusion is not a widely accepted care and further studies to confirm its benefits are required. Postnatal procedures include obligatory suction of the oral-pharyngeal cavity and nose before the first breath, and selective endotracheal suction only in depressed neonates or neonates born from thick meconium-stained amniotic fluid. Conventional therapy of meconium aspiration syndrome includes monitoring of vital functions, chest physiotherapy, site drainage, airway suction, oxygen supply, respiratory support, antibiotics, sedation, normal fluid balance and calories intake, and when indicated, agents stabilizing blood pressure and heart rate. New management methods of meconium aspiration syndrome, not recommended as standard procedures at present include high-frequency oscillatory or jet ventilation as a lifesaving therapy, the use of exogenous surfactant, surfactant lavage of the bronchial tree, liquid ventilation, and inhalation of nitric oxide. Extracorporeal membrane oxygenation is of considerable importance in the treatment of the most severe meconium aspiration syndrome, but its role is diminishing with the development of other therapeutic methods.