Journal of the Chinese Medical Association
Volume 71, Issue 2 , Pages 103-109, February 2008

Therapeutic Lung Lavage with Diluted Surfactant in Neonates with Severe Meconium Aspiration Syndrome

  • Chiao-Wei Lo

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Mei-Jy Jeng

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Mei-Jy Jeng, Department of Pediatrics, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C
    • ,
  • Feng-Yu Chang

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Ja-Fang Yang

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Yu-Sheng Lee

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Wen-Jue Soong

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Emergency and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • ,
  • Shu-Jen Chen

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Ren-Bin Tang

      Affiliations

    • Department of Pediatrics and Critical Care Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Received 29 June 2007; accepted 31 July 2007.

Article Outline

Meconium aspiration syndrome (MAS) may result in considerable morbidity and mortality in newborn infants. The current standard treatment is still in need of improvement for the most severe patients. We report 3 cases with devastating MAS that was successfully treated with therapeutic lung lavage. These cases were all delivered in local obstetrics clinics or hospitals with meconium-stained amniotic fluid and non-vigorous appearance at birth. However, no endotracheal suction was performed when they were born. All of them suffered from severe hypoxia and unstable vital signs despite there being high ventilatory settings when they were transferred to the tertiary medical center. Therapeutic lung lavage with diluted surfactant (Survanta, 5 mg/mL, 30 mL/kg in 2 aliquots) was performed within 24 hours of age. Bloody fluid (about 40–50% of total lavage amount) was recovered in all 3 cases. Although brief desaturation and bradycardia were observed during the procedures, 2 of them tolerated the procedures well and improved soon after lavage. The other patient received lung lavage in a relatively unstable condition and needed chest tapping to relieve bilateral pleural effusion. Their respiratory condition improved after the procedures, and they were all discharged within 1 month without major respiratory complications. These successful experiences are compatible with previous animal studies and other case reports with different lavage protocols. We conclude that therapeutic lung lavage may improve the outcome in newborn infants with severe MAS, and there were no significant adverse side effects observed. Before performing lung lavage, stabilization and optimal support may prevent unexpected results during and after lavage.

Key Words:  lavage , meconium , neonates , surfactant

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PII: S1726-4901(08)70084-4

doi:10.1016/S1726-4901(08)70084-4

Journal of the Chinese Medical Association
Volume 71, Issue 2 , Pages 103-109, February 2008

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