Steroids for the Management of Neonates With Meconium Aspiration Syndrome: A Systematic Review and Meta-analysis

Yeung, Telford; Jasani, Bonny; Shah, Prakesh S.

doi:10.1007/s13312-021-2199-1

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…As lung cells may produce NO from L-arginine due to NOS activity, L-arginine in this study was used as a positive control. Although corticosteroids are among the most effective anti-inflammatory agents used to treat many inflammatory diseases [ 110 ], the use of steroids is not recommended by the Cochrane database for the treatment of MAS [ 111 ], and a meta-analysis showed that steroid use did not decrease mortality or associated morbidities [ 112 ]. However, our experience and those reported by others have indicated that the outcomes of infants with MAS can be significantly improved by the administration of both systemic and inhaled steroids [ 113 , 114 , 115 ].…”

Section: Discussionmentioning

confidence: 99%

Approach to the Connection between Meconium Consistency and Adverse Neonatal Outcomes: A Retrospective Clinical Review and Prospective In Vitro Study

Fan

Pan

et al. 2021

Children

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Whether meconium-stained amniotic fluid (MSAF) serves as an indicator of fetal distress is under debate; however, the presence of MSAF concerns both obstetricians and pediatricians because meconium aspiration is a major contributor to neonatal morbidity and mortality, even with appropriate treatment. The present study suggested that thick meconium in infants might be associated with poor outcomes compared with thin meconium based on chart reviews. In addition, cell survival assays following the incubation of various meconium concentrations with monolayers of human epithelial and embryonic lung fibroblast cell lines were consistent with the results obtained from chart reviews. Exposure to meconium resulted in the significant release of nitrite from A549 and HEL299 cells. Medicinal agents, including dexamethasone, L-Nω-nitro-arginine methylester (L-NAME), and NS-398 significantly reduced the meconium-induced release of nitrite. These results support the hypothesis that thick meconium is a risk factor for neonates who require resuscitation, and inflammation appears to serve as the primary mechanism for meconium-associated lung injury. A better understanding of the relationship between nitrite and inflammation could result in the development of promising treatments for meconium aspiration syndrome (MAS).

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Section: Discussionmentioning

confidence: 99%

Approach to the Connection between Meconium Consistency and Adverse Neonatal Outcomes: A Retrospective Clinical Review and Prospective In Vitro Study

Fan

Pan

et al. 2021

Children

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“…As lung cells may produce NO from L-arginine due to NOS activity, L-arginine in this study was used as a positive control. Although corticosteroids are among the most effective anti-inflammatory agents used to treat many inflammatory diseases [110], the use of steroids is not recommended by the Cochrane database for the treatment of MAS [111], and a meta-analysis showed that steroid use did not decrease mortality or associated morbidities [112]. However, our experience and those reported by others have indicated that the outcomes of infants with MAS can be significantly improved by the administration of both systemic and inhaled steroids [113][114][115].…”

Section: Discussionmentioning

confidence: 77%

Stabilization and Resuscitation of Newborns

2023

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Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Preface to "Stabilization and Resuscitation of Newborns"The majority of newborns do not need medical interventions to manage the neonatal transition after birth. However, every year millions of newborns worldwide require respiratory support immediately after birth, and another considerable number of newborns additionally require extensive resuscitation including chest compressions and drug administration. Despite a significant increase in knowledge and development of enhanced therapy strategies over the past few years, morbidity and mortality caused by failures in neonatal transition remain an important health issue. The purpose of this book is to support or introduce novel concepts and add information in the area of the "Stabilization and Resuscitation of Newborns", aiming to improve neonatal care and, as the major objective, to enhance neuro-developmental outcomes. I believe that this book helps to contribute to consolidating the current body of information with the hopes of enhancing and stimulating further studies on all spectra of "Stabilization and Resuscitation of Newborns".

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“…Steroids reduce pulmonary inflammation on histology and improve oxygenation in animal studies. 23,24 Two recently published systematic reviews 25,26 have evaluated the role of steroids in MAS. There was no mortality benefit, but reduced hospital stay with…”

Section: Discussionmentioning

confidence: 99%

Prediction score for prolonged hospital stay in meconium aspiration syndrome: A multicentric collaborative cohort of south India

Rao¹,

Charki

Aradhya³

et al. 2022

Pediatric Pulmonology

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Background and Objective: With improved survival in neonates with meconium aspiration syndrome (MAS), the focus is currently on mitigating the morbidities. The objective of this study was to predict factors determining prolonged hospital stay in neonates with MAS.Materials and Methods: It was a retrospective cohort from five centers of south India between 2018 and 2020. Neonates ≥35 weeks of gestation admitted to neonatal intensive care unit with the diagnosis of MAS and requiring oxygen beyond 24 h of life were included in the study. The morbidities in the neonates with stay ≤7 days (short stay) were compared with >7 days (prolonged stay). Logistic regression by the backward stepwise method was used for predictive score creation.Results: Out of 347 neonates with MAS discharged home, 103 (29%) had a short stay and 244 (71%) had prolonged stay. The primary support beyond O 2 (continuous positive airway pressure/mechanical ventilation) (42% vs. 83%, p < 0.001), fractional inspired oxygen (FiO 2 ) at 1 h >30% (45% vs. 87%, p < 0.001), hypoxic ischemic encephalopathy (HIE) stage 2 or 3 (1% vs. 27%, p < 0.001), moderate-severe persistent pulmonary artery hypertension (PPHN) (3% vs. 31%, p < 0.001) were independent factors associated with prolonged stay on logistic regression. A prediction model was devised using weighted scores of these four associated morbidities. The clinical score thus developed had 83% sensitivity, 68% specificity for the prediction of prolonged stay (area under curve: 82%, 95% confidence interval [78-87], p < 0.001). Conclusion:More than two-thirds of neonates with MAS had prolonged stay. The primary support beyond oxygen, FiO 2 requirement >30%, Moderate to severe PPHN, HIE stage 2 or 3 were predictive of prolonged stay in neonates with MAS.

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Steroids for the Management of Neonates With Meconium Aspiration Syndrome: A Systematic Review and Meta-analysis

Cited by 7 publications

References 18 publications

Approach to the Connection between Meconium Consistency and Adverse Neonatal Outcomes: A Retrospective Clinical Review and Prospective In Vitro Study

Approach to the Connection between Meconium Consistency and Adverse Neonatal Outcomes: A Retrospective Clinical Review and Prospective In Vitro Study

Stabilization and Resuscitation of Newborns

Prediction score for prolonged hospital stay in meconium aspiration syndrome: A multicentric collaborative cohort of south India

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