Bronchoalveolar lavage with saline surfactant solution in the treatment of neonates with severe respiratory failure due to MAS,PIE,or BPD

Background: To assess of the safety and efficacy of tracheobronchial lavage with natural surfactant solution in term newborns with meconium aspiration syndrome (MAS)and preterm neonates with pulmonary interstitial emphysema (PIE),or bronchopulmonary dysplasia (BPD). Material/Methods: Neonates received 20 ml/kg of natural surfactant saline solution at concentration 5 mg phospholipid/ml.Analysis of oxygenation index (OI)and arterial-alveolar ratio (A-a DO 2 )were performed directly before the procedure and within 0,1,2,12,24, 48,72 hours after lavage.We compared values of FiO 2 ,MAP,PIP,pH,SpO 2 ,PaCO 2 ,OI,AaDO 2 ,before and after lavage.Results: We treated 29 neonates (11 with MAS,16 with BPD and 2 with PIE).In neonates with MAS there was a decrease of OI and AaDO 2 at 2,12,24,48 and 72h after lavage. Ventilatory settings necessary to keep PaO 2 and CO 2 in normal range at 24,48 and 72 hour after lavage were significantly lower when compared with baseline.In the neonates with BPD there was a drop of OI from 8.1 to 3.5 24 hours after the procedure,and of AaDO 2 from 808.4 mmHg to 134.2 mmHg in the same time interval. Neonates were extubated between 1 to 38 (mean 11.87)days after lavage.It was noticed that OI and A-aDO 2 at 24 and 48 hours after proce- dure had the greatest prognostic value.Conclusions: Surfactant lavage of bronchoalveolar tree is a safe procedure and may be effective in the treatment of neonatal MAS, PIE and BPD.

Keywords: surfactant, neonate,, Meconium, BPD, lavage