A Multicenter, Randomized, Controlled Trial Comparing Surfaxin (Lucinactant) Lavage With Standard Care for Treatment of Meconium Aspiration Syndrome

• Published in: Pediatrics (Evanston) 2002-06, Vol.109 (6), p.1081-1087
• Main Authors: Wiswell, Thomas E, Knight, Gail R, Finer, Neil N, Donn, Steven M, Desai, Hemant, Walsh, William F, Sekar, Krishnamurthy C, Bernstein, Graham, Keszler, Martin, Visser, Valya E, Merritt, T. Allen, Mannino, Frank L, Mastrioianni, Lisa, Marcy, Brian, Revak, Susan D, Tsai, Huei, Cochrane, Charles G
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aspiration pneumonia; Babies; Biological and medical sciences; Bronchoalveolar lavage; Bronchoalveolar Lavage - methods; Care and treatment; Clinical trials; Disease; Emergency and intensive care: neonates and children. Prematurity. Sudden death; Female; Health aspects; Humans; Infant, Newborn; Infants (Newborn); Intensive care medicine; Male; Meconium Aspiration Syndrome - blood; Meconium Aspiration Syndrome - therapy; Medical research; Medical sciences; Newborn infants; Oxygen - blood; Pediatrics; Pulmonary Surfactants - therapeutic use; Respiration, Artificial - methods; Respiratory system; Suction - methods; Treatment Outcome; Ventilator Weaning - statistics & numerical data
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.109.6.1081

Infants with meconium aspiration syndrome (MAS) have marked surfactant dysfunction. Airways and alveoli of affected neonates contain meconium, inflammatory cells, inflammatory mediators, edema fluid, protein, and other debris. The objective of this study was to compare treatment with bronchoalveolar lavage using dilute Surfaxin with standard therapy in a population of newborn infants with MAS. Inclusion criteria were 1) gestational age > or =35 weeks, 2) enrollment within 72 hours of birth, 3) diagnosis of MAS, 4) need for mechanical ventilation, and 5) an oxygenation index > or =8 and < or =25. Subjects were randomized to either lavage with Surfaxin or standard care (2:1 proportion). In lavaged infants, a volume of 8 mL/kg dilute Surfaxin (2.5 mg/mL) was instilled into each lung over approximately 20 seconds followed by suctioning after 5 ventilator breaths. The procedure was repeated twice. The third and final lavage was with a more concentrated solution (10 mg/mL) of Surfaxin. Twenty-two infants were enrolled (15 Surfaxin and 7 control). Demographic characteristics were similar. There were trends (not significant) for Surfaxin-lavaged infants to be weaned from mechanical ventilation earlier (mean of 6.3 vs 9.9 days, respectively), as well as to have a more rapid decline in their oxygenation indexes compared with control infants, the latter difference persisting for the 96-hour-long study period. The therapy was safe and generally well tolerated by the infants. Dilute Surfaxin lavage seems to be a safe and potentially effective therapy in the treatment of MAS. Data from this investigation support future prospective, controlled clinical trials of bronchoalveolar lavage with Surfaxin in neonates with MAS.