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Innovative neonatal ventilation and meconium aspiration syndrome.
Indian J Pediatr. 2003 May; 70(5):421-7.IJ

Abstract

Respiratory failure remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia/sepsis have a potential for increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options previously limited to inotropic support, conventional ventilatory management, respiratory alkalosis, paralysis and intravenousvasodilators have been replaced by high-frequency oscillatory ventilation (HFOV), surfactant, and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting surfactant deficiency or inactivation may contribute to neonatal respiratory failure exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. In this article, the authors place in context of a system-based strategy the prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized, and the least number of babies require innovative ventilatory support. At Pennsylvania Hospital, over a six-year period (1995 to 2000), 14.5% (3370/23,175 of live births babies were delivered with MSAF. These data show that 4.6% (155/3370) of babies with MSAF sustained MAS. Overall, 26% (40/155) of babies with MAS needed ventilatory support (or 0.17% of all live-births); of these only 20% (8/40 or 0.035% of live births) needed innovative ventilatory support. None died or needed ECMO. These data describe the impact of a system-based approach to prevent and manage adverse outcomes related to MSAF at regional Level III perinatal center.

Authors+Show Affiliations

Bhutani VK
Newborn Pediatrics, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, USA. vbhut@pahosp.com
Chima R
No affiliation info available
Sivieri EM
No affiliation info available

MeSH

HumansInfant, NewbornMeconium Aspiration SyndromeNitric OxidePulmonary SurfactantsRespiration, ArtificialRespiratory InsufficiencyRetrospective Studies

Pub Type(s)

Journal Article

Language

eng

PubMed ID

12841404

Citation

Bhutani, Vinod K., et al. "Innovative Neonatal Ventilation and Meconium Aspiration Syndrome." Indian Journal of Pediatrics, vol. 70, no. 5, 2003, pp. 421-7.
Bhutani VK, Chima R, Sivieri EM. Innovative neonatal ventilation and meconium aspiration syndrome. Indian J Pediatr. 2003;70(5):421-7.
Bhutani, V. K., Chima, R., & Sivieri, E. M. (2003). Innovative neonatal ventilation and meconium aspiration syndrome. Indian Journal of Pediatrics, 70(5), 421-7.
Bhutani VK, Chima R, Sivieri EM. Innovative Neonatal Ventilation and Meconium Aspiration Syndrome. Indian J Pediatr. 2003;70(5):421-7. PubMed PMID: 12841404.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Innovative neonatal ventilation and meconium aspiration syndrome. AU - Bhutani,Vinod K, AU - Chima,Ranjit, AU - Sivieri,Emidio M, PY - 2003/7/5/pubmed PY - 2003/8/6/medline PY - 2003/7/5/entrez SP - 421 EP - 7 JF - Indian journal of pediatrics JO - Indian J Pediatr VL - 70 IS - 5 N2 - Respiratory failure remains a major cause of morbidity and mortality in the neonatal population. Infants with hypoxemic respiratory failure because of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia/sepsis have a potential for increased survival with extracorporeal membrane oxygenation (ECMO). Other treatment options previously limited to inotropic support, conventional ventilatory management, respiratory alkalosis, paralysis and intravenousvasodilators have been replaced by high-frequency oscillatory ventilation (HFOV), surfactant, and inhaled nitric oxide (iNO). HFOV has been advocated for use to improve lung inflation while potentially decreasing lung injury through volutrauma. Other reports describe enhanced efficacy of HFOV when combined with iNO. Subsequent to studies reporting surfactant deficiency or inactivation may contribute to neonatal respiratory failure exogenous surfactant therapy has been implemented with apparent success. Recent studies have shown that iNO therapy in the neonate with hypoxemic respiratory failure can result in improved oxygenation and decreased need for ECMO. In this article, the authors place in context of a system-based strategy the prenatal, natal and postnatal management of babies delivered through meconium stained amniotic fluid (MSAF) so that adverse outcomes are minimized, and the least number of babies require innovative ventilatory support. At Pennsylvania Hospital, over a six-year period (1995 to 2000), 14.5% (3370/23,175 of live births babies were delivered with MSAF. These data show that 4.6% (155/3370) of babies with MSAF sustained MAS. Overall, 26% (40/155) of babies with MAS needed ventilatory support (or 0.17% of all live-births); of these only 20% (8/40 or 0.035% of live births) needed innovative ventilatory support. None died or needed ECMO. These data describe the impact of a system-based approach to prevent and manage adverse outcomes related to MSAF at regional Level III perinatal center. SN - 0019-5456 UR - https://www.unboundmedicine.com/medline/citation/12841404/Innovative_neonatal_ventilation_and_meconium_aspiration_syndrome_ DB - PRIME DP - Unbound Medicine ER -