What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome.
Meconium aspiration syndrome (MAS) is a life-threatening disorder in newborn infants. Universal intrapartum suction of infants with meconium stained amniotic fluid (MSAF) and postnatal suction of vigorous infants have been used in an attempt to decrease the incidence and severity of the disease by clearing the airway. Both procedures have been proven fruitless when challenged through randomised control trials (RCTs). Endotracheal intubation and suctioning are currently recommended only for non-vigorous infants. Respiratory failure in infants with MAS is frequently treated initially with conventional or synchronized mechanical ventilation. Surfactant administration and high-frequency ventilation (HFV) are commonly used as rescue therapy for severe cases. Nitric oxide (NO) is added when severe pulmonary hypertension is demonstrated. ECMO is an option when other treatments have failed. In the pathophysiology of severe MAS, asphyxia and pulmonary hypertension are considered to be more important than the obstruction of the airways and/or damage to the lung produced by meconium.
Vain
Nestor E
NE
Hospital Sanatorio Trinidad, University of Buenos Aires, Chenaut 1831, Buenos Aires, 1426, Argentina. vain@fundasamin.org.ar
Szyld
Edgardo G
EG
Prudent
Luis M
LM
Aguilar
Adriana M
AM
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D036861:Delivery, Obstetric / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007442:Intubation, Intratracheal; D008471:Meconium Aspiration Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D017410:Practice Guidelines as Topic; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D012121:Respiration, Artificial; D013256:Steroids / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D011663:Pulmonary Surfactants; D013256:Steroids