Table 4.
Surfactant therapy for neonates with meconium aspiration syndrome.
| Surfactant therapy | Delivery method | Mechanical ventilation | Notes | Ref. |
|---|---|---|---|---|
| BLES® | ETT | Yes | Beneficial in full-term newborns with respiratory failure associated with pneumonia or MAS | [146] |
| Bovine surfactant extract | ETT | N/A | Effective in full-term infants with respiratory failure due to MAS and RDS A randomized controlled trial at an earlier stage is needed |
[147] |
| Curosurf® | N/A | N/A | Surfactant therapy may be a useful intervention for severe MAS Randomized controlled clinical trials are needed |
[148] |
| Survanta® | ETT instillation | Yes | Effective therapy, if started within 6 h after birth | [149] |
| Saline lavage in large volume (FRC-like) followed by Alveofact® | ETT instillation | HFOV | Interesting approach in the treatment of MAS | [150] |
| Survanta lavage | ETT instillation | Yes | An effective and safe method for treatment of severe MAS Multicenter randomized controlled trial is needed |
[151] |
| Surfacten® lavage followed by surfactant replacement | ETT | Yes | Surfactant lavage an effective and safe method for treatment of severe MAS | [152] |
| Survanta lavage | ETT | Yes | Only a short-term effect in decreasing oxygenation index in neonates with MAS | [153] |
| Surfaxin® lavage | ETT | Yes | Safe and potentially effective therapy | [154] |
| Three different none: 1: Control 2: BAL with diluted Survanta 3: Group 2 plus single dexamethasone dose (iv.) |
ETT | Yes | Group 3 in the first hours of life may be an effective treatment for severe MAS | [155] |
| Survanta BAL | ETT | Yes | Beneficial effects on pulmonary mechanics persisted for at least 48 h after administration | [156] |
| Curosurf | ETT | Yes | The approach is worth considering when ECMO is unavailable for the treatment of severe MAS | [157] |
| Curosurf | ETT | Yes plus manual ventilation with 100% O2 for 1–2 min after each instillation | Surfactant may have a role in the treatment of severe MAS in term and near-term infants | [158] |
| Survanta lavage | Catheter inserted down ETT | Yes after administration | A randomized controlled trial is needed | [159] |
| Survanta lavage | Instillation | HFOV after delivery | May improve the outcome in newborn infants with severe MAS Prior to lung lavage, stabilization and optimal support may prevent unexpected results during and after lavage |
[160] |
| Two none followed by iNO: Survanta lavage Bolus surfactant |
ETT | Yes after delivery | No advantage of surfactant lavage therapy over bolus surfactant treatment in infants with MAS complicated by PPHN | [161] |
BAL: Bronchoalveolar lavage; ECMO: Extracorporeal membrane oxygenation; ETT: Endotracheal tube; FRC: Functional residual capacity; HFOV: High frequency oscillatory ventilation; iNO: Inhaled nitric oxide; iv.: Intravenous; MAS: Meconium aspiration syndrome; PPHN: Persistent pulmonary hypertension; RDS: Respiratory distress syndrome.