Small versus large volume dilute surfactant lavage for meconium aspiration syndrome.
BACKGROUND
Surfactant lavage has been used to treat neonatal meconium aspiration syndrome (MAS).


OBJECTIVE
To assess the effects of lavage with a small volume of dilute surfactant in neonates with MAS, and compare the results with those of historical controls treated with larger volumes.


METHODS
From August 2002 to June 2005, we treated 11 newborns with MAS using 20 ml of dilute surfactant at a phospholipid concentration of 10 mg/ml (SVL group). We compared the results with those of 9 infants previously treated with large-volume lavage (LVL group), using 40 ml of dilute surfactant, 5 mg/ml.


RESULTS
Both groups were similar at baseline except for a higher mean birth weight in the LVL group (3.29+/-0.36 vs 2.92+/-0.4 kg, P = 0.04). The lavage procedure was longer in the LVL than the SVL group (48.89 +/-7.41 vs. 30.91+/-5.83 mins, P <0.001). Measures of oxygenation, including mean PaO2, oxygenation index, and arterial/alveolar 02 ratio, showed no significant difference between the two groups. Adverse events in the LVL group included transient hypoxemia in 3 infants and white- out on chest x-ray in 5 cases. None of the patients in the SVL group had these findings. The peak mean airway pressure in.the LVL group was higher than that in the SVL group (16.0+/-2. 65 vs 13.3+/-3.01 cmH2O, P = 0.046).


CONCLUSIONS
SVL has the same benefits in neonatal MAS as LVL. However, SVL appears to be associated with fewer adverse events.
Hung
Han-Yang
HY
Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
Jim
Wai-Tim
WT
Hsu
Chyong-Hsin
CH
Chang
Jui-Hsing
JH
Peng
Chun-Chi
CC
Shih
Shin-Lin
SL
Chang
Hung-Yang
HY
Kao
Hsin-An
HA
D001794:Blood Pressure; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000503:physiopathology / Q000628:therapy*; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D007507:Therapeutic Irrigation
D011663:Pulmonary Surfactants