TY - JOUR
T1 - Saline lavage with substitution of bovine surfactant in term neonates with meconium aspiration syndrome (MAS) transferred for extracorporeal membrane oxygenation (ECMO): A pilot study
AU - Möller, Jens C.
AU - Kohl, Martina
AU - Reiss, Irwin
AU - Diederich, Wiebke
AU - Nitsche, Esther M.
AU - Göpel, Wolfgang
AU - Gortner, Ludwig
N1 - Copyright:
Copyright 2007 Elsevier B.V., All rights reserved.
PY - 1999
Y1 - 1999
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=2442769272&partnerID=8YFLogxK
U2 - 10.1186/cc302
DO - 10.1186/cc302
M3 - Journal articles
AN - SCOPUS:2442769272
SN - 1364-8535
VL - 3
SP - 19
EP - 22
JO - Critical Care
JF - Critical Care
IS - 1
ER -