Lavage with exogenous surfactant in neonatal meconium aspiration syndrome

Background: Meconium aspiration syndrome is a disease in near term infants which requires invasive techniques to decrease mortality. Lavage of the tracheobronchial tree with exogenous surfactant has been shown to be effective in animal studies. We studied the effectiveness of this technique in newborn infants and compared them with a historical control group. Patients and Methods: From 1987 to 1998, we treated 18 neonates with meconium aspiration syndrome. In 11 babies a lavage with bovine derived diluted surfactant was carried out immediately after admission. In 7 infants of the control group only the meconium was suctioned or a lavage with saline performed. There were no differences between both groups concerning other therapeutic interventions like high frequency ventilation or inhalative NO. The control group contained significantly more outborn patients compared with the lavage group. Criteria of effectiveness were change in oxygenation index (OI), duration of mechanical ventilation and oxygen supplementation greater than 30%. In addition, the two groups were compared for incidence of death, need for ECMO, and air leaks. Results: One infant of the lavage group died, one had to be transferred to ECMO (no significant difference). There was a significant decrease in OI after surfactant lavage from 22 at admission to 5.1 one day later (p = 0.007), whereas in the control group, OI did not change significantly over time (15.8 to 11.4). There were no differences in the duration of mechanical ventilation or oxygen supplementation. Conclusions: In our study, lavage with exogenous surfactant had only a short-term effect in decreasing OI in neonates with meconium aspiration. Larger numbers of patients need to be investigated to demonstrate an improvement in long-term outcome.