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Dini G, Ceccarelli S, Celi F, Semeraro CM, Gorello P, Verrotti A. Meconium aspiration syndrome: from pathophysiology to treatment. Ann Med Surg (Lond) 2024; 86:2023-2031. [PMID: 38576961 PMCID: PMC10990371 DOI: 10.1097/ms9.0000000000001835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
Meconium aspiration syndrome (MAS) is a clinical condition characterized by respiratory distress in neonates born through meconium-stained amniotic fluid (MSAF). Despite advances in obstetric practices and perinatal care, MAS remains an important cause of morbidity and mortality in term and post-term newborns. Since the 1960s, there have been significant changes in the perinatal and postnatal management of infants born through MSAF. Routine endotracheal suctioning is no longer recommended in both vigorous and non-vigorous neonates with MSAF. Supportive care along with new treatments such as surfactant, inhaled nitric oxide, and high-frequency ventilation has significantly improved the outcome of MAS patients. However, determining the most appropriate approach for this condition continues to be a topic of debate. This review offers an updated overview of the epidemiology, etiopathogenesis, diagnosis, management, and prognosis of infants with MAS.
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Affiliation(s)
- Gianluca Dini
- Neonatal Intensive Care Unit, “Santa Maria” Hospital, Terni
| | | | - Federica Celi
- Neonatal Intensive Care Unit, “Santa Maria” Hospital, Terni
| | | | - Paolo Gorello
- Department of Chemistry, Biology and Biotechnology, University of Perugia, Perugia
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Wei Q, Chen W, Liang Q, Song S, Li J. Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis. Am J Perinatol 2023; 40:1272-1278. [PMID: 35016248 DOI: 10.1055/s-0041-1741034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Meconium is a common finding in amniotic fluid and placental specimens, particularly in term and post-term pregnancies. The objective of this paper was to perform a meta-analysis to examine the impact of endotracheal suctioning on the occurrence of meconium aspiration syndrome (MAS), mortality, and complications. STUDY DESIGN PubMed, EMBASE, and the Cochrane library were systematically searched for comparative studies. Odds ratios (ORs), weighted mean differences (WMDs), and corresponding 95% confidence intervals (CIs) were used to compare the outcomes. RESULTS Twelve studies were included in the meta-analysis. There were no significant impacts of endotracheal suctioning on the occurrence of MAS (OR = 3.05, 95% CI: 0.48-19.56), mortality (OR = 1.25, 95% CI: 0.35-4.44), the need for mechanical ventilation (OR = 4.20, 95% CI: 0.32-54.72), the occurrence of pneumothorax (OR = 0.99, 95% CI: 0.34-2.85), persistent pulmonary hypertension of the newborn (PPHN), (OR = 1.31, 95% CI: 0.58-2.98), hypoxic-ischemic encephalopathy (HIE) (OR = 0.82, 95% CI: 0.52-1.30), and length of stay (WMD = -0.11, 95% CI: -0.99-0.77). CONCLUSION Routine endotracheal suctioning at birth is not useful in preventing MAS, mortality, mechanical ventilation, PPHN, HIE, and prolonged length of stay in neonates born through MSAF. KEY POINTS · Routine suctioning is not recommended for newborns.. · Endotracheal aspiration is not beneficial for MAS.. · Future research may focus on selected neonates..
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Affiliation(s)
- Qing Wei
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Wenjing Chen
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Qian Liang
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Shurong Song
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Jia Li
- Department of Obstetrics, The Third Central Hospital of Tianjin, Hedong District, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin, China
- Department of obstetrics, Artificial Cell Engineering Technology Research Center, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Meconium Aspiration Syndrome in Animal Models: Inflammatory Process, Apoptosis, and Surfactant Inactivation. Animals (Basel) 2022; 12:ani12233310. [PMID: 36496831 PMCID: PMC9740025 DOI: 10.3390/ani12233310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/18/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Meconium Aspiration Syndrome is a condition that causes respiratory distress in newborns due to occlusion and airway inflammation, and surfactant inactivation by meconium. This condition has been described in animal species such as canids, sheep, cattle, horses, pigs, and marine mammals. In its pathogenesis, the pulmonary epithelium activates a limited inflammatory response initiated by cytokines causing leukocyte chemotaxis, inhibition of phagocytosis, and pathogen destruction. Likewise, cytokines release participates in the apoptosis processes of pneumocytes due to the interaction of angiotensin with cytokines and the caspase pathway. Due to these reactions, the prevalent signs are lung injury, hypoxia, acidosis, and pneumonia with susceptibility to infection. Given the importance of the pathophysiological mechanism of meconium aspiration syndrome, this review aims to discuss the relevance of the syndrome in veterinary medicine. The inflammatory processes caused by meconium aspiration in animal models will be analyzed, and the cellular apoptosis and biochemical processes of pulmonary surfactant inactivation will be discussed.
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Arruza L, Barata L, Vierge E, Rodríguez MJ, Del Pozo A, Hind W, Martínez-Orgado J. Cannabidiol Reduces Inflammatory Lung Damage After Meconium Aspiration in Newborn Piglets. Front Pediatr 2022; 10:862035. [PMID: 35733813 PMCID: PMC9207394 DOI: 10.3389/fped.2022.862035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
AIM To assess the effects of cannabidiol (CBD) on lung damage in a piglet model of meconium aspiration syndrome (MAS). MATERIALS AND METHODS Meconium aspiration syndrome was modelled in newborn piglets via intratracheal instillation of 20% meconium in saline collected from healthy newborn humans. Piglets were treated i.v. with 5 mg/kg CBD (MAS + CBD) or Vehicle (MAS + VEH) 30 min after MAS induction and monitored for 6 h. Ventilated piglets without meconium instillation served as controls (CTL). Ventilatory and haemodynamic monitoring, histological and biochemical studies assessed the effects of treatment. RESULTS Post-insult administration of CBD reduced MAS-induced deterioration of gas exchange, improving respiratory acidosis (final pH 7.38 ± 0.02, 7.22 ± 0.03 and 7.33 ± 0.03 and final pCO2 39.8 ± 1.3, 60.4 ± 3.8 and 45.7 ± 3.1 mmHg for CTL, MAS + VEH and MAS + CBD, respectively, p < 0.05). These beneficial effects were obtained despite the less aggressive ventilatory settings required for CBD-treated animals (final minute volume 230 ± 30, 348 ± 33 and 253 ± 24 mL/kg/min and final Oxygenation Index 1.64 ± 0.04, 12.57 ± 3.10 and 7.42 ± 2.07 mmHg for CTL, MAS + VEH and MAS + CBD, respectively, p < 0.05). CBD's beneficial effects on gas exchange were associated with reduced histological lung damage, reduced leucocyte infiltration and oedema (histopathological score 1.6 ± 0.3, 8.6 ± 1.4 and 4.6 ± 0.7 points for CTL, MAS + VEH and MAS + CBD, respectively, p < 0.05), as well as reduced TNFα production (0.04 ± 0.01, 0.34 ± 0.06 and 0.12 ± 0.02 A.U. for CTL, MAS + VEH and MAS + CBD, respectively, p < 0.05). Moreover, CBD improved blood pressure stability (final mean blood pressure 74.5 ± 0.2, 62.2 ± 6.2, and 78.67 ± 4.1 mmHg for CTL, MAS + VEH and MAS + CBD, respectively, p < 0.05). CONCLUSION Cannabidiol reduces histologic lung damage and inflammation in a piglet model of MAS. This translates into improved gas exchange and blood pressure stability.
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Affiliation(s)
- Luis Arruza
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Lorena Barata
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Eva Vierge
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Maria José Rodríguez
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Aaron Del Pozo
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | | | - José Martínez-Orgado
- Department of Neonatology, Hospital Clinico San Carlos-Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
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Changes in mean arterial blood pressure during sildenafil use in neonates with meconium aspiration syndrome or sepsis. Am J Ther 2015; 22:125-31. [PMID: 23344111 DOI: 10.1097/mjt.0b013e31826fc4ec] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to evaluate changes in mean blood pressure (MBP) in late preterm and term newborns with meconium aspiration syndrome (MAS) or sepsis who, in addition to inhaled nitric oxide (iNO), received enteral sildenafil for treatment of persistent pulmonary hypertension of the newborn. Data on sildenafil dosing, MBP, and vasopressor/inotrope use were collected for 72 hours after initiation of sildenafil. Groups were compared between "low dose" (<3 mg·kg·d) versus "high dose" (≥ 3 mg·kg·d) and "early" (<7 postnatal days) versus "late" (≥ 7 postnatal days) administration of sildenafil. Seventeen patients were identified. Ten and 7 patients received "low-dose" and "high-dose" sildenafil, respectively, and 8 and 9 patients were started on sildenafil "early" and "late," respectively. At the doses used, sildenafil treatment of infants with MAS and sepsis was not associated with changes in MBP. In addition, vasopressor/inotropic support was weaned in all groups. During the first 72 hours of enteral sildenafil administration in neonates with pulmonary hypertension of the newborn secondary to MAS or sepsis, no significant decrease in MBP or increase in vasopressor/inotrope requirement occurred.
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