Elsevier

The Journal of Pediatrics

Volume 158, Issue 3, March 2011, Pages 383-389.e2
The Journal of Pediatrics

Original Article
Randomized Controlled Trial of Lung Lavage with Dilute Surfactant for Meconium Aspiration Syndrome

https://doi.org/10.1016/j.jpeds.2010.08.044Get rights and content

Objective

To evaluate whether lung lavage with surfactant changes the duration of mechanical respiratory support or other outcomes in meconium aspiration syndrome (MAS).

Study design

We conducted a randomized controlled trial that enrolled ventilated infants with MAS. Infants randomized to lavage received two 15-mL/kg aliquots of dilute bovine surfactant instilled into, and recovered from, the lung. Control subjects received standard care, which in both groups included high frequency ventilation, nitric oxide, and, where available, extracorporeal membrane oxygenation (ECMO).

Results

Sixty-six infants were randomized, with one ineligible infant excluded from analysis. Median duration of respiratory support was similar in infants who underwent lavage and control subjects (5.5 versus 6.0 days, P = .77). Requirement for high frequency ventilation and nitric oxide did not differ between the groups. Fewer infants who underwent lavage died or required ECMO: 10% (3/30) compared with 31% (11/35) in the control group (odds ratio, 0.24; 95% confidence interval, 0.060-0.97). Lavage transiently reduced oxygen saturation without substantial heart rate or blood pressure alterations. Mean airway pressure was more rapidly weaned in the lavage group after randomization.

Conclusion

Lung lavage with dilute surfactant does not alter duration of respiratory support, but may reduce mortality, especially in units not offering ECMO.

Section snippets

Methods

This was an international multicenter randomized controlled trial of dilute surfactant lavage in MAS, approved by institutional ethical review committees, national ethical review committees, or both. Participating centers (n = 20) were tertiary level neonatal intensive care units, each equipped with standard therapeutic modalities for MAS, including HFOV and iNO. Half the participating centers had access to ECMO. A training workshop was conducted at each center, including a simulation of lavage

Results

The numbers of infants screened, eligible for inclusion, excluded, and randomized are shown in Figure 2. Of 328 infants ventilated with MAS during the study period, 118 (36%) met inclusion criteria, with 12 excluded on the basis of cardiorespiratory instability (Figure 2). The 66 infants were enrolled from 13 participating centers (Appendix). Demographic and clinical characteristics of the two groups were similar at the time of randomization (Table I). All infants were from singleton

Discussion

MAS is a serious newborn respiratory disorder for which there is a frustrating lack of specific therapy.1 In this study, we examined the impact of lung lavage in MAS, with a technique developed in a series of laboratory experiments14 and evaluated in a preliminary study in ventilated infants.22 We found no evidence for an effect of lavage on duration of respiratory support, but there appeared to be a reduction in mortality, especially when infants ostensibly saved with ECMO were considered with

References (35)

  • A. Karimova et al.

    Neonatal extracorporeal membrane oxygenation: practice patterns and predictors of outcome in the UK

    Arch Dis Child Fetal Neonatal Ed

    (2009)
  • D.C. Tyler et al.

    Mechanical and chemical damage to lung tissue caused by meconium aspiration

    Pediatrics

    (1978)
  • N. Tran et al.

    Sequential effects of acute meconium obstruction on pulmonary function

    Pediatr Res

    (1980)
  • A.M. Davey et al.

    Meconium aspiration syndrome: physiological and inflammatory changes in a newborn piglet model

    Pediatr Pulmonol

    (1993)
  • G.M. Cleary et al.

    Exudative lung injury is associated with decreased levels of surfactant proteins in a rat model of meconium aspiration

    Pediatrics

    (1997)
  • C.W. Bae et al.

    Morphology and function of pulmonary surfactant inhibited by meconium

    Pediatr Res

    (1998)
  • C.G. Cochrane et al.

    Bronchoalveolar lavage with KL4-surfactant in models of meconium aspiration syndrome

    Pediatr Res

    (1998)
  • Cited by (0)

    Supported by grants from the Australian National Health and Medical Research Council (284539 and 384100) and the Murdoch Childrens Research Institute. Abbott Pty Ltd. provided surfactant for lavaged infants. The funding sources had no role in the study design, data collection, data analysis, or preparation of the report. The authors declare no conflicts of interest.

    This trial is registered with the Australia and New Zealand (Clinical Trial Register #12606000290594).

    List of members of the lessMAS Trial Study Group is available at www.jpeds.com (Appendix).

    View full text