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

Background: Meconium aspiration syndrome (MAS) is still a condition associa ted with a high mortality, and many patients require extracorporeal membran e oxygenation (ECMO) as rescue therapy. Beneficial effects of surfactant an d perflubron lavage have been reported. However, pure surfactant supplement ation 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 n eonates transferred for ECMO and fulfilling ECMO criteria with a saline lav age 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 ECM O therapy were treated with saline lavage (5-10 cm(3)/kg body weight, as lo ng as green colored retrieval was observed) and resupplementation with bovi ne surfactant (Alveofact, Boehringer, Ingelheim, Germany). The OI at admiss ion and 3 h after this procedure was compared using the t-test for paired s amples. 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 hyper tension and obstructive airway disease, no simple causative therapy is poss ible. 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.