Saline lavage with substitution of bovine surfactant in term neonates with meconium aspiration syndrome (MAS) transferred for extracorporeal membrane oxygenation (ECMO): a pilot study

Background:
Meconium aspiration syndrome (MAS) is still a condition associated
with a high mortality, and many patients require extracorporeal membrane
oxygenation (ECMO) as rescue therapy. Beneficial effects of surfactant and
perflubron lavage have been reported. However, pure surfactant supplementation
has not been proven to be beneficial in the most severe forms of MAS. This
study was performed to demonstrate an improvement in oxygenation in neonates
transferred for ECMO and fulfilling ECMO criteria with a saline lavage and
surfactant resupplementation.

      Methods:
      Twelve newborns with MAS [gestational age 36–40 weeks, mean birth
            weight 3200 g, age 4–16 h, oxygenation index (OI) > 40] transferred for ECMO
            therapy were treated with saline lavage (5–10 cm3/kg body weight, as
            long as green colored retrieval was observed) and resupplementation with bovine
            surfactant (Alveofact, Boehringer, Ingelheim, Germany). The OI at admission and
            3 h after this procedure was compared using the t-test for paired
            samples. ECMO was available as rescue therapy at all times.


      Results:
      The OI decreased from 49.4 (SD ± 13.3) to 27.4 (SD ± 7.3),
            P < 0.01. The decrease was sustained in nine patients, three
            patients required ECMO and all patients survived.


      Conclusions:
      As MAS is a condition with parenchymal damage, pulmonary
            hypertension and obstructive airway disease, no simple causative therapy is
            possible. Surfactant application after removal of meconium by extensive lavage
            is feasible as long as 16 h after birth even in infants considered for ECMO
            therapy; it might reduce the necessity of ECMO.