A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome.
OBJECTIVE
Infants with meconium aspiration syndrome (MAS) have marked surfactant dysfunction. Airways and alveoli of affected neonates contain meconium, inflammatory cells, inflammatory mediators, edema fluid, protein, and other debris. The objective of this study was to compare treatment with bronchoalveolar lavage using dilute Surfaxin with standard therapy in a population of newborn infants with MAS.


METHODS
Inclusion criteria were 1) gestational age > or =35 weeks, 2) enrollment within 72 hours of birth, 3) diagnosis of MAS, 4) need for mechanical ventilation, and 5) an oxygenation index > or =8 and < or =25. Subjects were randomized to either lavage with Surfaxin or standard care (2:1 proportion). In lavaged infants, a volume of 8 mL/kg dilute Surfaxin (2.5 mg/mL) was instilled into each lung over approximately 20 seconds followed by suctioning after 5 ventilator breaths. The procedure was repeated twice. The third and final lavage was with a more concentrated solution (10 mg/mL) of Surfaxin.


RESULTS
Twenty-two infants were enrolled (15 Surfaxin and 7 control). Demographic characteristics were similar. There were trends (not significant) for Surfaxin-lavaged infants to be weaned from mechanical ventilation earlier (mean of 6.3 vs 9.9 days, respectively), as well as to have a more rapid decline in their oxygenation indexes compared with control infants, the latter difference persisting for the 96-hour-long study period. The therapy was safe and generally well tolerated by the infants.


CONCLUSIONS
Dilute Surfaxin lavage seems to be a safe and potentially effective therapy in the treatment of MAS. Data from this investigation support future prospective, controlled clinical trials of bronchoalveolar lavage with Surfaxin in neonates with MAS.
Wiswell
Thomas E
TE
Discovery Laboratories, Inc, Doylestown, Pennsylvania, USA. twiswell@mail.som.sunysb.edu
Knight
Gail R
GR
Finer
Neil N
NN
Donn
Steven M
SM
Desai
Hemant
H
Walsh
William F
WF
Sekar
Krishnamurthy C
KC
Bernstein
Graham
G
Keszler
Martin
M
Visser
Valya E
VE
Merritt
T Allen
TA
Mannino
Frank L
FL
Mastrioianni
Lisa
L
Marcy
Brian
B
Revak
Susan D
SD
Tsai
Huei
H
Cochrane
Charles G
CG
D018893:Bronchoalveolar Lavage / Q000379:methods*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000097:blood / Q000628:therapy*; D010100:Oxygen / Q000097:blood; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000379:methods; D013396:Suction / Q000379:methods; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000706:statistics & numerical data
D011663:Pulmonary Surfactants; D010100:Oxygen