OBJECTIVES: To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). METHODS: A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. RESULTS: There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. CONCLUSIONS Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.
Amniotic Fluid ; Humans ; Infant ; Infant, Newborn ; Intubation, Intratracheal ; Meconium ; Meconium Aspiration Syndrome/therapy* ; Retrospective Studies ; Suction

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP^®) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP^® guidelines over the past 60 years.
Female ; Infant, Newborn ; Humans ; Child ; Meconium Aspiration Syndrome/therapy* ; Meconium ; Resuscitation ; Amniotic Fluid ; Intubation, Intratracheal/methods* ; Infant, Newborn, Diseases ; China

Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; drug therapy ; Pulmonary Surfactants ; therapeutic use

OBJECTIVEMeconium aspiration syndrome (MAS) is a disease of the term and near-term infant that is associated with considerable respiratory morbidity. The purpose of this study was to investigate effects of inhaled nitric oxide (iNO) in oxygenation and outcome of newborns with MAS.

METHODSEligible patients diagnosed as severe MAS admitted consecutively to the neonatal intensive care unit (NICU) of Hebei Children's Hospital from January 2004 to June 2006 were included in the study. The patients with an oxygenation index (OI) > or = 15 were randomized in a nonblinded manner to receive either iNO (NO group, n = 21) or no NO (control group, n = 25). Patients with an OI > or = 15 after enrollment were treated with iNO at 15 ppm initially. The response to iNO was assessed according to the increase in arterial PaO(2) and oxygen saturation (SpO(2)) after exposure to the starting concentration for 60 minutes. A response of 10 mm Hg (1 mm Hg = 0.133 kPa) increase in PaO(2) and a 10% increase in SpO(2) was assessed responsive to iNO. All patients were treated in the same neonatal unit and received the same standard therapy throughout the study period. Arterial blood gas tensions, pulmonary arterial pressure and systemic arterial blood pressures were recorded at baseline, 1 hour, and 24 hours in all patients. Methemoglobin levels were obtained at 12 - 24 hours after inhaled NO treatment. Parameters of fraction of inspired oxygen (FiO(2)), OI, mortality, ventilation time, and incidence of intraventricular hemorrhage (IVH, grade III-IV) were recorded. Informed consent was obtained from parents before enrollment. The protocol and the informed consent forms were approved by the ethic committee of the hospital before patient enrollment.

RESULTSThere was no significant difference in gestational age, birth weight, gender ratio, age at admission in hours, c-section delivery between the two groups, and no significant difference was found in respiratory mechanics parameters between the two groups at baseline. The duration of iNO was 34.90 +/- 16.41 hours. At the beginning of the treatment, no significant differences were detected in the OI and PAP between the two groups. One hour later, OI and PAP of NO group decreased significantly (OI, F = 35.27, P < 0.01, PAP, F = 24.30, P < 0.01), while in control group the difference was not found until 24 hours (OI, F = 20.16, P < 0.01, PAP, F = 101.22, P < 0.01). There were significant differences in PAP at 1, 24 hours between the two groups (1 h, t = 2.41, P < 0.05; 24 h, t = 3.11, P < 0.01). The methemoglobin levels were normal. Compared to the controls, hospital stay (t = 2.86, P < 0.05), duration of the need for oxygen supplement (t = 2.53, P < 0.05) and ventilation time were shorter (t = 2.41, P < 0.05), whereas mortality (chi(2) = 0.21, P > 0.05) and incidence of IVH (chi(2) = 0.00, P > 0.05) were not significantly different between the groups.

CONCLUSIONSiNO could effectively improve the oxygenation and shorten the ventilation time and hospital stay without augmentation of risk of IVH and pneumothorax in these neonatal patients.

Administration, Inhalation ; Female ; Humans ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; therapy ; Nitric Oxide ; administration & dosage ; therapeutic use ; Treatment Outcome

OBJECTIVEThe efficacy of pulmonary surfactant (PS) replacement therapy for meconium aspiration syndrome (MAS) remains controversial. This study aimed to evaluate the efficacy of PS therapy in neonates with MAS by a meta-analysis.

METHODSRandomized controlled trials (RCTs) on the treatment of MAS with PS were searched electronically in medical debases including PubMed, Science Citation Index, The Cochrane Central Register of Controlled Trials, Ovid, EBSCOhost, BIOSIS previews, Chinese BioMedical Literature Database, Wanfang Database and VIP Chinese Sci-Tech Periodical Database. The Cochrane Handbook 5.0.2 was employed to evaluate methodological quality. RevMan 5.0.25 software was used for the meta-analysis.

RESULTSEight RCTs including 512 MAS neonates (257 cases in the PS treatment group and 255 cases in the control group) were enrolled in this meta-analysis. The meta-analysis showed that PS treatment reduced oxygenation index (MD=-2.59; 95%CI: -4.33, -0.86; P=0.003), increased arterial oxygen/alveolar oxygen ratio (MD=0.05; 95%CI: 0.05, 0.06; P<0.00001), shortened hospitalization days (MD=-4.94; 95%CI: -7.44, -2.44; P=0.0001) and decreased mortality rate (OR=0.47; 95%CI: 0.24, 0.93; P=0.03) significantly. There were no statistical differences in the durations of mechanical ventilation and oxygen therapy, and the incidences of air leak, pulmonary hemorrhage and intracranial hemorrhage between the PS treatment and control groups.

CONCLUSIONSCurrently published evidence from RCTs suggests that PS replacement therapy is effective for MAS, however because of the limited quantity and quality of trials enrolled in the study, further evidence from RCTs is needed to prove the efficacy.

Female ; Humans ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; drug therapy ; mortality ; physiopathology ; Pulmonary Surfactants ; therapeutic use ; Randomized Controlled Trials as Topic

OBJECTIVETo evaluate the clinical effect of endotracheal lavage with porcine pulmonary surfactant (PS) in term neonates with severe meconium aspiration syndrome (MAS).

METHODSA total of 136 full-term infants with severe MAS who were admitted to the neonatal intensive care unit between January 2010 and June 2013 were randomly and equally divided into PS lavage and PS injection groups. In the PS lavage group, patients were treated with endotracheal lavage using 3-5 mL of diluted PS (12 mg/mL) each time, and the PS injection group was given PS by intratracheal injection at the first dose of 200 mg/kg. Blood gas, oxygenation index (OI), and PaO2/FiO2 (P/F) of the two groups were evaluated before and 2, 12, 24, and 48 hours after the treatment, and the duration of mechanical ventilation, complication rate, and cure rate were compared between the two groups.

RESULTSCompared with the PS injection group, the PS lavage group had significantly higher PaO2 and P/F ration and significantly lower PaCO2 and OI at 12, 24, and 48 hours post-treatment (P<0.01), a significantly shorter duration of mechanical ventilation (P<0.01), a significantly smaller amount of PS (P<0.01), a significantly lower complication rate (P<0.05), and a significantly higher cure rate (97% vs 88%; P<0.05).

CONCLUSIONSCompared with the intratracheal injection of PS, endotracheal lavage with diluted PS in term neonates with severe MAS can increase ventilation and oxygenation efficiency, shorten the duration of mechanical ventilation, reduce the complication rate, and increase the cure rate, indicating that this method is a safe and effective therapeutic strategy.

Animals ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; drug therapy ; Pulmonary Surfactants ; administration & dosage ; Swine ; Therapeutic Irrigation ; Trachea

OBJECTIVETo study the clinical effect and safety of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal severe meconium aspiration syndrome (MAS) complicated by neonatal pulmonary hemorrhage (NPH).

METHODSA total of 48 children with severe MAS complicated by NPH were enrolled, and a retrospective analysis was performed for the clinical effects of HFOV+PS (trial group, 25 children) and HFOV alone (control group, 23 children). The blood gas parameters, oxygenation index (OI), PaO/FiO(P/F) value, duration of pulmonary hemorrhage, ventilation time, length of hospital stay, incidence of complications, and outcome were compared between the two groups.

RESULTSAt 6, 12, 24, and 48 hours after treatment, the trial group had significantly better PaO, OI, and P/F value than the control group (P<0.05). Compared with the control group, the trial group had significantly shortened ventilation time and duration of pulmonary hemorrhage (P<0.05). There were no significant differences in the length of hospital stay, the incidence of complications, and cure rate between the two groups (P>0.05).

CONCLUSIONSHFOV combined with PS can better improve oxygenation function and shorten the duration of NPH and ventilation time. Meanwhile, it does not increase the incidence of adverse events. Therefore, it is a safe and effective therapy.

Combined Modality Therapy ; Female ; Hemorrhage ; therapy ; High-Frequency Ventilation ; Humans ; Infant, Newborn ; Lung Diseases ; therapy ; Male ; Meconium Aspiration Syndrome ; complications ; drug therapy ; Pulmonary Surfactants ; therapeutic use

OBJECTIVETo investigate the clinical value of humidified high-flow nasal cannula (HHFNC) as a respiratory support after extubation by comparing it with nasal continuous positive airway pressure (NCPAP) in neonates with meconium aspiration syndrome (MAS) and persistent pulmonary hypertension of the newborn (PPHN).

METHODSA total of 78 neonates with MAS and PPHN were randomly administered with HHFNC or NCPAP immediately after extubation. The following indices were compared between the two groups: blood gas parameters, duration of noninvasive ventilation, rate of extubation failure, and incidence of complications, such as nasal damage, abdominal distension, and intraventricular hemorrhage.

RESULTSThere were no significant differences in the rate of extubation failure, PaO, PCO, and PaO/FiOratio at one hour after NCPAP or HHFNC, duration of noninvasive ventilation, time to full enteral feeding, length of hospital stay, and incidence of intraventricular hemorrhage between the two groups (P>0.05). The HHFNC group had significantly lower incidence of nasal damage (5.0% vs 31.6%; P<0.05) and incidence of abdominal distension (7.5% vs 34.2%; P<0.05) than the NCPAP group.

CONCLUSIONSBoth NCPAP and HHFNC can be used as the sequential therapy for neonates with MSA and PPHN after extubation, and they both have a definite effect. As a new strategy of respiratory support, HHFNC is better tolerated, and has fewer side effects than NCPAP.

Airway Extubation ; adverse effects ; Continuous Positive Airway Pressure ; instrumentation ; methods ; Female ; Humans ; Hypertension, Pulmonary ; therapy ; Infant, Newborn ; Male ; Meconium Aspiration Syndrome ; therapy ; Noninvasive Ventilation ; instrumentation ; methods

OBJECTIVETo study the clinical efficacy of porcine pulmonary surfactant (PS) combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome (MAS).

METHODSSeventy neonates with MAS were enrolled for a prospective study. The neonates were randomly assigned to PS alone treatment group and PS+budesonide treatment group (n=35 each). The PS alone treatment group was given PS (100 mg/kg) by intratracheal instillation. The treatment group was given budesonide suspension (0.25 mg/kg) combined with PS (100 mg/kg).

RESULTSThe rate of repeated use of PS in the PS+ budesonide group was significantly lower than that in the PS alone group 12 hours after treatment (p<0.05). The improvement of PaO/FiO, TcSaO, PaO, and PaCOin the PS+ budesonide group was significantly greater than that in the PS alone group 6, 12, and 24 hours after treatment (p<0.05). The chest X-ray examination showed that the pulmonary inflammation absorption in the PS+ budesonide group was significantly better than that in the PS alone group 48 hours after treatment (p<0.05). The incidence of complications in the PS+budesonide group was significantly lower than that in the PS alone group (p<0.05), and the average hospitalization duration was significantly shorter than that in the PS alone group (p<0.01).

CONCLUSIONSPS combined with budesonide suspension intratracheal instillation for the treatment of neonatal MAS is effective and superior to PS alone treatment.

Animals ; Budesonide ; administration & dosage ; Female ; Humans ; Infant, Newborn ; Length of Stay ; Male ; Meconium Aspiration Syndrome ; complications ; drug therapy ; Prospective Studies ; Pulmonary Surfactants ; administration & dosage ; Suspensions ; Swine ; Trachea

Dexamethasone ; therapeutic use ; Glucocorticoids ; pharmacology ; therapeutic use ; Humans ; Infant, Newborn ; Meconium Aspiration Syndrome ; drug therapy ; physiopathology ; Methylprednisolone ; therapeutic use ; Prednisolone ; therapeutic use