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

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.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.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.Meconium aspiration syndrome (MAS) is a leading cause of severe respiratory failure in term neonates and is associated with high mortality. Extracorporeal membrane oxygenation (ECMO) has improved the outcome of infants with MAS significantly [1]. In addition, the enforcement of standardized management algorithms, with detailed advice for pharyngeal and in some cases tracheal suctioning, have reduced the incidence of MAS, especially in Europe [2,3,4,5,6,7].In our state, only four cases in 29 000 deliveries were registered in 1997 [8]. In cases of MAS with moderate severity, exogenous surfactant therapy improves oxygenation and increases the rate of survival [9].Infants are still transferred, however, to ECMO centers after prolonged periods of hypoxemia; in extreme conditions, with oxygenation indices > 40, the transport-associated mortality is high [10]. Treatment options that improve the conditions in severe MAS and can be used in all NICU are therefore warranted.As MAS is a condition