Abstract
The aim of study was to evaluate the efficacy of treatment of severe meconium aspiration syndrome/MAS/complicated with persistent pulmonary hypertension/PPHN/in the improvement of oxygenation. The designed therapeutic approach consisted of surfactant lung lavage/SLL/and surfactant instillation together with Nitric Oxide inhalation/iNO/. The study population was randomized into two groups: group A/n= 7/treated with SLL, surfactant instillation and iNO, and group B/n= 6/treated with surfactant instillation and iNO. Criteria for inclusion: maturity >35 weeks of gestation, time after delivery < 24 hours, presence of fluid containing meconium below vocal cords, respiratory insufficiency demanding mechanical ventilation/Fi0240%/, radiological changes, and echocardiographic features of pulmonary hypertension.
Method: SLL was performed with natural surfactant solution (Survanta) in concentration of 5mg of phospholipids/1 ml 0,9% NaCl, a dose of 15ml of solution per 1 kg. A dose of 100 mg of Surfactant per 1 kg was applied. The initial NO dose was 20 ppm. The parameters analyzed: Pa02, MAP, Fi02, IO, aADO2 at 0h, 1h, 2h, 4h, 24h, 48h of treatment.
Results: (Mean value ± SD). PaO2 0h- Group A- 48,4± 14,9mmHg vs. Group B- 45,0± 14,3mmHg (NS); 1h- Group A- 114,3± 49,8 mmHg vs. Group B- 46,7± 14,9mmHg (p< 0,05). MAP 0h- Group A- 14,3± 4,1 vs. Group B- 13,8± 8,2 (NS); 24h- Group A- 4,0± 3,5 vs. Group B- 8,0± 3,7 (p< 0,05). FiO2 0h- Group A- 95,7± 11,3% vs. Group B- 95,0± 12,2% (NS); 2h- Group A- 67,1± 19,9% vs. Group B 96,6± 8,1% (p< 0,05); 4h- Group A- 57,1± 16,5% vs. Group B-89,1± 5,6% (p< 0,05). IO 0h- Group A- 29,8± 12,4 vs. Group B- 32,3± 24,9 (NS); 1h- Group A- 11,2± 12,4 vs. Group B- 28,8± 12,0 (p< 0,05); 2h- Group A- 10,0± 5,5 vs. Group B- 26,7± 19,0 (p< 0,05); 4h- Group A - 6,3± 6,4 vs. Group B- 22,1± 18,4 (p< 0,05); 24h- Group A - 2,7± 2,2 vs. Group B - 10,4± 8,0 (p< 0,05). a/ADO2 0h- Group A- 575,6± 91,0mmHg vs. Group B- 589,5± 95,8mmHg (NS); 2h- Group A- 364,2± 128,8mmHg vs. Group B- 581,18± 71,1mmHg (p< 0,05); 4h- Group A- 306,3± 122,8mmHg vs. Group B-506,2± 112,6mmHg (p< 0,05).
Conclusions: The associated treatment of SLL together with iNO allows a significant improvement of oxygenation and reduction of parameters of mechanical ventilation.
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Gadzinowski, J., Szymankiewicz, M. & Kowalska, K. 91 Surfactant Lung Lavage and Inhaled Nitric Oxide in The Treatment of Meconium Aspiration Syndrome 1- Influence on Oxygenation. Pediatr Res 56, 479 (2004). https://doi.org/10.1203/00006450-200409000-00114
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DOI: https://doi.org/10.1203/00006450-200409000-00114