Current strategy for management of meconium aspiration syndrome.

Meconium aspiration syndrome (MAS) is characterized by the atelectasis due to the complete airway obstruction, emphysema and air leak syndrome resulted from the partial obstruction of airway, chemical pneumonitis, and surfactant dysfunction. As far as meconium is present in the airway, exogenous surfactant will be inactivated rather quickly even given as multiple doses. MAS can easily develop persistent pulmonary hypertension of the newborn. Therefore, the removal of meconium from the airway rather than the surfactant replacement therapy should be the cardinal step for the treatment of MAS. Our previous studies revealed that the removal of meconium from airway by the tracheobronchial lavage with diluted surfactant solution, 100 mg/10 mL/Kg of Surfactant-TA, resulted in the recovery of both blood gas values and lung compliance to the normal range. Thus, the current strategies of management of MAS are the selective intubation with toileting only on infants with severe distress at birth, and the early airway lavage with diluted surfactant solution, followed by high frequency oscillatory ventilation, which may prevent the further injuries in the fragile neonatal lung.