Efficacy of three treatment schedules in severe meconium aspiration syndrome.
OBJECTIVE
To compare three different schedules in severe meconium aspiration syndrome (MAS) treatment: standard, bronchoalveolar lavage (BAL) with diluted surfactant, and diluted surfactant BAL plus a single early dexamethasone dose.


METHODS
Twenty-four full-term newborns with severe MAS (needing mechanical ventilation and with oxygenation index > or = 15) were divided into three groups: group I (historical control group; n = 6) treated with standard therapy; group II (n = 7) treated in the first hours of life with one BAL using diluted surfactant (beractant 5 mg/mL) in a volume of 15 mL/kg in four aliquots; and group III (n = 11) treated with one diluted surfactant BAL and a previous single dose of intravenous dexamethasone (0.5 mg/kg).


RESULTS
At 12 h, groups II and III showed a significant improvement in oxygenation index (OI) compared with group I (14.7% and 27.0% vs -19.6% respectively; p = 0.012). Group III also showed a significantly lower OI than group I at 24 h (63.6% vs -27.9%) and at 48 h (87.1% vs 49.6%). Group III, in comparison to group I, showed a lower FiO2 requirement at 12 h (0.66 vs 1), at 24 h (0.4 vs 0.87) and at 48 h (0.35 vs 0.67), and a decrease in the number of days of inhaled nitric oxide administration, mechanical ventilation, oxygen therapy and hospitalisation period. All patients from groups II and III survived and none developed pneumothorax or respiratory infections.


CONCLUSIONS
Diluted surfactant BAL in the first hours of life combined with an intravenous single dose of dexamethasone may be an effective treatment for severe MAS.
Neonatology Service, Hospital Clinic, Institut Clinic de Ginecologia, Obstetrícia i Neonatologia, Unitat Integrada de Pediatria, IDIBAPS, Universitat de Barcelona, Spain.
M D
MD
Salvia-Roigés
X
X
Carbonell-Estrany
J
J
Figueras-Aloy
J M
JM
Rodríguez-Miguélez
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001688:Biological Products / Q000627:therapeutic use*; D018893:Bronchoalveolar Lavage; D003907:Dexamethasone / Q000627:therapeutic use*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000628:therapy*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012121:Respiration, Artificial
D000893:Anti-Inflammatory Agents; D001688:Biological Products; D011663:Pulmonary Surfactants; D003907:Dexamethasone; C072197:beractant