Pharmacotherapy for meconium aspiration

Abstract

In this article we have attempted to review the current pharmacological treatment options for infants with meconium aspiration syndrome with or without persistent pulmonary hypertension. These treatments include ventilatory support, surfactant treatment and inhaled nitric oxide (INO), in addition to older and newer pharmacological treatments. These include sedatives, muscle relaxants, alkali infusion, antibiotics and the newer vasodilators. Many aspects of treatment, including ventilatory care, surfactant treatment and the use of INO, are reviewed in great detail in this issue. On the other hand, many newer pharmacological modalities of treatment described here have not been evaluated with randomized control trials. We have given an overview of these emerging therapies.

Meconium aspiration syndrome: challenges and solutions

“…Other pulmonary vasodilators like phosphodiesterase 5 inhibitors (sildenafil, dipyridamole, and zaprinast) have been tried in newborns, but the number treated is few, with no large control studies available to date. 71 …”

Persistent pulmonary hypertension of the newborn

“…However induced paralysis is controversial. There have been some isolated reports in the literature of increased mortality with the use of pancuronium bromide, promotion of atelectasis of dependent lung regions and ventilation perfusion mismatch (Asad and Bhat, 2008). Therefore routine use of pancuronium or any other neuromuscular blocking agent in ventilated preterm newborn infants cannot be recommended based on current evidence as uncertainty remains regarding the long-term pulmonary and neurologic effects and the safety of prolonged use of neuromuscular blocking agents in ventilated newborn infants (Cools and Offringa, 2005).…”

Cannabidiol Reduces Inflammatory Lung Damage After Meconium Aspiration in Newborn Piglets

“…There is no specific treatment of MAS other than lung lavage with surfactant, but the efficacy and safety of this procedure is controversial ( 1 ). Surfactant without lavage and iNO offer some beneficial effects in selected cases ( 7 ). Thus, management is mostly supportive, dealing with ventilatory and hemodynamic problems, and preventing complications such as brain damage ( 7 ).…”

“…Surfactant without lavage and iNO offer some beneficial effects in selected cases ( 7 ). Thus, management is mostly supportive, dealing with ventilatory and hemodynamic problems, and preventing complications such as brain damage ( 7 ). Steroids did show some promise in preclinical studies as a therapeutic tool against MAS-induced inflammation, but this failed to translate into clear benefits in randomised controlled trials (RCT) ( 5 ).…”