Steven M; Donn MD; Dalton JMD. Surfactant Replacement Therapy in the Neonate:

Beyond Respiratory Distress Syndrome. RESPIRATORY CARE



Retrospective analysis

To evaluate the effects of surfactant replacement therapy on two diseases: meconium aspiration syndrome (MAS) and respiratory distress syndrome.

- Meconium is a mixture of gastrointestinal secretions, epithelial cells and other substances that appear in the amniotic fluid, many of them, mainly bile salts, can inactivate the surfactant, in addition to having a toxic effect on the lung, causing chemical pneumonia, among others.

- The use of surfactant is well known in respiratory distress syndrome, however, in a randomized controlled study in 1996, it was observed that the use of surfactant in MAS improved oxygenation and decreased air leakage, as well as respiratory morbidity severe and length of stay. Thus, as the lung washing technique with surfactant has become another alternative.

- There is still much to learn about pharmacology and pharmacokinetics of surfactants; however, studies propose that surfactant replacement therapy can overcome inactivation and production, emphasizing the need to observe long-term results, in addition to measures to reduce short-term effects and the need for extracorporeal membrane oxygenation (ECMO).

Fraser WD, Hofmeyr J, Lede R, Faron G, Alexander S, Goffinet F, Ohlsson A, Goulet C, Turcot-Lemay L, Prendiville W, Marcoux S, Laperrière L, Roy C, Petrou S, Xu HR, Wei B. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med



Controlled clinical trial

Determine whether amnioinfusion

reduces the risk of outcome of perinatal, moderate or severe death in meconium aspiration syndrome (MAS), or both. And evaluate the

effect of the intervention on the risk of cesarean section, other important neonatal indicators and

maternal diseases.

- A total of 1975 women were randomized, 986 for the amnioinfusion group and 989 for the control group. Perinatal death, moderate or severe meconium aspiration syndrome, or both, occurred in 44 children of women belonging to the amnioinfusion group and 35 children of women belonging to the control group. There were 10 perinatal deaths, 5 in each group.

- The cesarean section rate was 31.8% in the amnioinfusion group and in the control group the rate was 29%. Some serious complications, such as maternal peripartum fever, uterine rupture, pre-delivery hemorrhage, hysterectomy and disseminated intravascular coagulation did not differ significantly between groups.

- In women in labor and with thick amniotic fluid, the amnioinfusion procedure did not reduce the risk of moderate or severe MAS, perinatal death or other neonatal or maternal disorders, therefore, it should not be recommended for the prevention of meconium aspiration syndrome.

Meritano J, Abrahan MS, Pietro SVD, Fernández V, Gerez, G. Síndrome de dificultad respiratoria asociado a líquido amniótico meconial en recién nacidos de término y postérmino: incidencia, factores de riesgos y morbimortalidad. Rev. Hosp. Mat. Inf.



Transversional observational study

To estimate the incidence of meconium amniotic fluid (MAL) and the relationship between respiratory distress syndrome, the association with risk factors and morbidity in term and post-term newborns at Maternity Hospital “Ramón Sardá”

- Clinical histories of newborns were selected from 2007 to 2008, the sample had 1150 with thick MAL and 2300 with clear MAL. The populations had similar characteristics, such as a higher incidence of cesarean section and primiparity in the thick MAL group, increasing with gestational age.

- Refers to follow the recommendations of the Academy

American Pediatrics and Cochrane reviews, which suggest aspirating the depressed newborn only once, using surfactant and mechanical ventilation to decrease complications and mortality.

- The risk of developing respiratory distress syndrome is 2.5 times higher in newborns with thick MAL compared to clear MAL, with a greater tendency to escape air, mortality and lower Apgar score.