Lung Lavage with Dilute Surfactant vs. Bolus Surfactant for Meconium Aspiration Syndrome

Abstract

Objective: To compare the effectiveness of lung lavage with surfactant vs. bolus surfactant treatment in meconium aspiration syndrome (MAS).

Patients and methods: This randomized controlled trial included newborns ventilated with MAS. In lavage group (n = 17) 30 ml/kg of diluted porcine surfactant was instilled into the lung. In bolus group (n = 16) porcine surfactant (100 mg/kg) was administered as bolus. Respiratory outcomes and mortality were compared between groups.

Results: Duration of respiratory support was found to be similar between lavage and bolus groups (3 vs. 3.5 days, p = 0.36). Death or requirement for extracorporeal membrane oxygenation (ECMO) was 12% vs. 6%; respectively (RR: 2, 95% CI 0.16-24.48; p = 1.0). Duration of oxygen therapy, high-frequency ventilation or inhaled nitric oxide requirement did not differ among the groups.

Conclusion: Lung lavage did not show any advantage over bolus therapy on duration of respiratory support. The incidence of pneumothorax and surfactant re-administration decreased nonsignificantly in lavage group.

Clinical trial registration: We registered the trial to ClinicalTrials.gov (http://clinicaltrials.gov) under identifier NCT02041546.

Registry name: Lung Lavage With Dilute Poractant Alfa for Meconium Aspiration Syndrome.

Keywords: lung lavage; meconium; surfactant.