Activation of Toll-like receptors in meconium aspiration syndrome

Anand, V. Vijay; Basu, Sriparna; Yadav, Sher Singh; Narayan, Gopeshwar; Bd, Bhatia; Kumar, Ashok

doi:10.1038/jp.2017.169

Cited by 10 publications

(6 citation statements)

References 37 publications

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“…30 In addition, even if some meconium could be aspirated from the distal airways, there is still a high possibility of some of them remaining plugged. 18 In addition to the mechanical concept regarding the failure to aspirate the meconium, MAS induces pulmonary and systemic pathophysiological changes that include inactivation of surfactant, 31 pulmonary hypertension, 32 and activation of immunity, 33 which would lead to poor outcomes even if all meconium were removed. Therefore, the current guidelines from the ACOG do not recommend the routine intrapartum suctioning of all newborns with MSAF.…”

Section: Discussionmentioning

confidence: 99%

Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis

et al. 2022

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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

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Section: Discussionmentioning

confidence: 99%

Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis

et al. 2022

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“…It is possible that the failure of endotracheal suctioning to prevent MAS could be attributed to occurrence of aspiration of meconium in utero and inability to retrieve meconium from trachea due to migration to distal airways [ 29 ]. In addition, other pathophysiological mechanisms of MAS, including surfactant inactivation, persistent pulmonary hypertension, and inactivation of Toll-like receptors may also contribute to the lack of a benefit seen with suctioning [ 2 , 3 , 5 , 29 , 32 ]. The majority of cases of severe MAS requiring mechanical ventilation have a background of non-reassuring fetal heart rate monitoring, neonatal depression, and in many cases thick meconium, which could support the theory of in utero damage [ 4 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of neonates born through meconium-stained amniotic fluid pre and post 2015 NRP guideline implementation

2023

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A shift in the Neonatal Resuscitation Program (NRP) guidelines occurred in 2015 from routine intubation and endotracheal suctioning of all meconium-stained non-vigorous infants towards less aggressive interventions based on response to initial resuscitation. This study aims to examine the impact of this change on outcomes of non-vigorous infants born through meconium-stained amniotic fluid at a level III academic NICU encompassing years before and after the change in guideline. This single-center retrospective study compared NICU therapies and clinical outcomes of 117 non-vigorous newborns pre-guideline implementation to 106 non-vigorous newborns post-guideline implementation. Nearly two thirds of infants in the pre-guideline cohort received endotracheal suctioning with recovery of meconium compared to less than a third of infants in the post-guideline cohort (p<0.01). Though a higher proportion of the pre-guideline cohort were admitted to the NICU for respiratory issues compared to the post-guideline cohort, the two groups did not differ significantly with regard to morbidity and therapies. Despite a marked reduction in rates of intubation and endotracheal suctioning, there is no difference in outcomes between pre-guideline implementation vs post-guideline implementation in non-vigorous meconium-stained infants, supporting the recent NRP guideline change and highlighting the benefit of expectant management.

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“…They identify meconium components and endogenous ligands (e.g., alarmins) released when the tissular damage causes ischemia, as well as events of alveolitis or pneumonitis [ 8 ]. According to Anand et al [ 53 ], MAS pathogenesis is associated with the expression of TLR1, TLR4, TLR9, and TLR7 receptors and the initiation of the inflammatory cascade. Upon recognizing foreign or harmful agents, pro-inflammatory substances are activated.…”

Section: Mas and The Pulmonary Inflammatory Processmentioning

confidence: 99%

Meconium Aspiration Syndrome in Animal Models: Inflammatory Process, Apoptosis, and Surfactant Inactivation

Mota-Rojas

Villanueva-García

Mota-Reyes

et al. 2022

Animals

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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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Activation of Toll-like receptors in meconium aspiration syndrome

Abstract: There is activation of TLRs in neonates with MAS. We speculate that these TLRs probably act as endogenous ligands for various components of meconium that initiate the inflammatory cascade of MAS and contribute to its pathogenesis.

Cited by 10 publications

References 37 publications

Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis

Effect of Endotracheal Suctioning on Infants Born through Meconium-Stained Amniotic Fluid: A Meta-analysis

Outcomes of neonates born through meconium-stained amniotic fluid pre and post 2015 NRP guideline implementation

Meconium Aspiration Syndrome in Animal Models: Inflammatory Process, Apoptosis, and Surfactant Inactivation

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