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中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (03) : 249 -256. doi: 10.3877/cma.j.issn.1673-5250.2020.03.001

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全民健康助力全面小康

新生儿胎粪吸入综合征的防治研究现状
刘莉1, 唐军1,†()   
  1. 1. 四川大学华西第二医院新生儿科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
  • 收稿日期:2020-02-22 修回日期:2020-05-09 出版日期:2020-06-01
  • 通信作者: 唐军

Current status of prevention and treatment of neonatal meconium aspiration syndrome

Li Liu1, Jun Tang1,†()   

  1. 1. Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-02-22 Revised:2020-05-09 Published:2020-06-01
  • Corresponding author: Jun Tang
  • About author:
    Corresponding author: Tang Jun, Email:
  • Supported by:
    National Natural Science Foundation of China(81300524, 81630038, 81771643, 81971433, 81971428); National Major Program of Ministry of Science and Technology of China(2017YFA0104200); Fund of National Clinical Key Specialties Development (Neonatology)(1311200003303); Science and Technology Planning Project of Science and Technology Department of Sichuan Province(2016TD0002)
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刘莉, 唐军. 新生儿胎粪吸入综合征的防治研究现状[J]. 中华妇幼临床医学杂志(电子版), 2020, 16(03): 249-256.

Li Liu, Jun Tang. Current status of prevention and treatment of neonatal meconium aspiration syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(03): 249-256.

新生儿胎粪吸入综合征(MAS)是一种威胁新生儿生命的呼吸系统疾病，导致的新生儿死亡率高。MAS可导致新生儿出现呼吸衰竭、气漏综合征、持续肺动脉高压、多脏器功能损伤等严重并发症。随着近年围生技术的发展，MAS诊治手段不断提高，从而使该病患儿存活率增高。笔者拟就MAS的最新防治研究现状进行阐述，旨在探讨对MAS患儿的产前、产时处理及产后新生儿呼吸道管理、药物治疗、呼吸支持治疗、吸入一氧化氮(iNO)、体外膜肺氧合(ECMO)技术、亚低温治疗等相关措施，对MAS患儿预后的影响。

关键词: 胎粪吸入综合征, 肺表面活性物质相关蛋白质类, 一氧化氮, 投药，吸入, 低温，人工, 连续气道正压通气, 体外膜肺氧合, 婴儿，新生

Neonatal meconium aspiration syndrome (MAS) is a life-threatening respiratory disease with high mortality. MAS can lead to respiratory failure, air leakage syndrome, persistent pulmonary hypertension, multiple organ function damage and other serious complications. In recent years, with the development of perinatal technology, the diagnosis and treatment of MAS has been continuously improved, thus increasing the survival rate of children with MAS. The authors intend to review the latest research status of prevention and treatment of MAS, in order to explore the effects of prenatal and intrapartum management, drug therapy, respiratory support therapy, inhaled nitric oxide (iNO), technology of extracorporeal membrane oxygenation (ECMO), mild hypothermia therapy and other related measures on the prognosis of children with MAS.

Key words: Meconium aspiration syndrome, Pulmonary surfactant-associated proteins, Nitric oxide, Administration, inhalation, Hypothermia, induced, Continuous positive airway pressure, Extracorporeal membrane oxygenation, Infant, newborn
[1]
Huang L, Winokur EJ. A sticky situation: meconium aspiration in the emergency department [J]. J Emerg Nurs, 2019, 45(1): 6-11. DOI: 10.1016/j.jen.2018.06.007.
[2]
Deng Y, Wang R, Zhou X, et al. Fetal, neonatal, and infant death in central China (Hubei): A 16-year retrospective study of forensic autopsy cases [J]. Medicine (Baltimore), 2019, 98(23): e15788. DOI: 10.1097/MD.0000000000015788.
[3]
Committee on Obstetric Practice. Committee opinion No. 689: delivery of a newborn with meconium-stained amniotic fluid [J]. Obstet Gynecol, 2017, 129(3): e33-e34. DOI: 10.1097/AOG.0000000000001950.
[4]
Calkovska A, Mokra D, Calkovsky V, et al. Clinical considerations when treating neonatal aspiration syndromes [J]. Expert Rev Respir Med, 2019, 13(2): 193-203. DOI: 10.1080/17476348.2019.1562340.
[5]
Sushma N, Anu T, Deepak C. Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid [J]. Cochrane Database Syst Rev, 2017, (5): CD012671. DOI: 10.1002/14651858.CD012671.
[6]
Saccone G, Berghella V. Induction of labor at full term in uncomplicated singleton gestations: a systematic review and Meta-analysis of randomized controlled trials [J]. Am J Obstet Gynecol, 2015, 213(5): 629-636. DOI: 10.1016/j.ajog.2015.04.004.
[7]
Gülmezoglu AM, Crowther CA, Middleton P, et al. Induction of labour for improving birth outcomes for women at or beyond term [J]. Cochrane Database Syst Rev, 2012, (6): CD004945. DOI: 10.1002/14651858.CD004945.pub3.
[8]
Gluck O, Kovo M, Tairy D, et al. The effect of meconium thickness level on neonatal outcome [J]. Early Hum Dev, 2020, 142: 104953. DOI: 10.1016/j.earlhumdev.2020.104953
[9]
Brabbing-Goldstein D, Nir D, Cohen D, et al. Preterm meconium-stained amniotic fluid is an ominous sign for the development of chorioamnionitis and for in utero cord compression [J]. J Matern Fetal Neonatal Med, 2017, 30(17): 2042-2045. DOI: 10.1080/14767058.2016.1236246.
[10]
Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, et al. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections [J]. Cochrane Database Syst Rev, 2014, (11): CD007772. DOI: 10.1002/14651858.CD007772.pub3.
[11]
Chabra S. Evolution of delivery room management for meconium-stained infants: recent updates [J]. Adv Neonatal Care, 2018, 18(4): 267-275. DOI: 10.1097/ANC.0000000000000522
[12]
Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: neonatal resuscitation: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care [J]. Circulation, 2015, 132(18 Suppl 2): S543-S560. DOI: 10.1161/CIR.0000000000000267.
[13]
Viraraghavan VR, Nangia S, Prathik BH, et al. Yield of meconium in non-vigorous neonates undergoing endotracheal suctioning and profile of all neonates born through meconium-stained amniotic fluid: a prospective observational study [J]. Paediatr Int Child Health, 2018, 38(4): 266-270. DOI: 10.1080/20469047.2018.1508809.
[14]
Chiruvolu A, Miklis KK, Chen E, et al. Delivery room management of meconium-stained newborns and respiratory support [J]. Pediatrics, 2018, 142(6): e20181485. DOI: 10.1542/peds.2018-1485.
[15]
Kumar A, Kumar P, Basu S, et al. Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial [J]. Eur J Pediatr, 2019, 178(12): 1825-1832. DOI: 10.1007/s00431-019-03463-z.
[16]
中国新生儿复苏项目专家组. 中国新生儿复苏指南(2016年北京修订)[J]. 中华围产医学杂志，2016, 19(7): 481-486. DOI: 10.3760/cma.j.issn.1007-9408.2016.07.001.
[17]
Hofmeyr GJ, Xu H, Eke AC. Amnioinfusion for meconium-stained liquor in labour [J]. Cochrane Database Syst Rev, 2014, (1): CD000014. DOI: 10.1002/14651858.CD000014.pub4.
[18]
Dad N, Abushama M, Konje JC, et al. What is the role of amnioinfusion in modern day obstetrics? [J]. J Matern Fetal Neonatal Med, 2015, 29(17): 2823-2827. DOI: 10.3109/14767058.2015.1105953.
[19]
Goel A, Nangia S, Saili A, et al. Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial [J]. Eur J Pediatr, 2015, 174(2): 237-243. DOI: 10.1007/s00431-014-2385-4.
[20]
Kopincova J, Calkovska A. Meconium-induced inflammation and surfactant inactivation: specifics of molecular mechanisms [J]. Pediatr Res, 2016, 79(4): 514-521. DOI: 10.1038/pr.2015.265.
[21]
Natarajan CK, Sankar MJ, Jain K, et al. Surfactant therapy and antibiotics in neonates with meconium aspiration syndrome: a systematic review and Meta-analysis [J]. J Perinatol, 2016, 36( Suppl 1): S49-S54. DOI: 10.1038/jp.2016.32.
[22]
K M, Batra P, Faridi M, et al. Procalcitonin as predictor of bacterial infection in meconium aspiration syndrome [J]. Am J Perinatol, 2018, 35(8): 769-773. DOI: 10.1055/s-0037-1615793.
[23]
Hofer N, Jank K, Strenger V, et al. Inflammatory indices in meconium aspiration syndrome [J]. Pediatr Pulmonol, 2016, 51(6): 601-606. DOI: 10.1002/ppul.23349.
[24]
Sorsa A. Diagnostic significance of white blood cell count and C-reactive protein in neonatal sepsis, Asella Referral Hospital, South East Ethiopia [J]. Open Microbiol J, 2018, 12: 209-217. DOI: 10.2174/1874285801812010209.
[25]
Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome - 2016 update [J]. Neonatology, 2017, 111(2): 107-125. DOI: 10.1159/000448985.
[26]
El Shahed AI, Dargaville PA, Ohlsson A, et al. Surfactant for meconium aspiration syndrome in term and late preterm infants [J]. Cochrane Database Syst Rev, 2014, (12): CD002054. DOI: 10.1002/14651858.CD002054.pub3.
[27]
Chettri S, Bhat BV, Adhisivam B, et al. Current concepts in the management of meconium aspiration syndrome [J]. Indian J Pediatr, 2016, 83(10): 1125-1130. DOI: 10.1007/s12098-016-2128-9.
[28]
Mikolka P, Kopincova J, Kosutova P, et al. Anti-IL-8 antibody potentiates the effect of exogenous surfactant in respiratory failure caused by meconium aspiration [J]. Exp Lung Res, 2018, 44(1): 40-50. DOI: 10.1080/01902148.2017.1420272.
[29]
Kopincova J, Mikolka P, Kolomaznik M, et al. Modified porcine surfactant enriched by recombinant human superoxide dismutase for experimental meconium aspiration syndrome [J]. Life Sci, 2018, 203: 121-128. DOI: 10.1016/j.lfs.2018.04.036.
[30]
Mikolka P, Kopincová J, Košútová P, et al. Lung inflammatory and oxidative alterations after exogenous surfactant therapy fortified with budesonide in rabbit model of meconium aspiration syndrome [J]. Physiol Res, 2016, 65(Suppl 5): S653-S662.
[31]
Garg N, Choudhary M, Sharma D, et al. The role of early inhaled budesonide therapy in meconium aspiration in term newborns: a randomized control study [J]. J Matern Fetal Neonatal Med, 2016, 29(1): 36-40. DOI: 10.3109/14767058.2014.985202.
[32]
Lin CH, Jeng MJ, Kuo BI, et al. Effects of surfactant lavage combined with intratracheal budesonide instillation on meconium-injured piglet lungs[J]. Pediatr Crit Care Med, 2016, 17(6): e287-e295. DOI: 10.1097/PCC.0000000000000729.
[33]
Ota C, Gopallawa I, Ivanov V, et al. Protection of meconium-induced lung epithelial injury by protease inhibitors[J]. J Lung Pulm Respir Res, 2017, 4(5): 145-155. DOI: 10.15406/jlprr.2017.04.00145.
[34]
Gandhi CK, Holmes R, Gewolb IH, et al. Degradation of lung protective angiotensin converting enzyme-2 by meconium in human alveolar epithelial cells: a potential pathogenic mechanism in meconium aspiration syndrome [J]. Lung, 2019, 197(2): 227-233. DOI: 10.1007/s00408-019-00201-y.
[35]
Vain NE, Szyld EG, Prudent LM, et al. What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome [J]. Early Hum Dev, 2009, 85(10): 621-626. DOI: 10.1016/j.earlhumdev.2009.09.013.
[36]
Dargaville PA. Respiratory support in meconium aspiration syndrome: a practical guide [J]. Int J Pediatr, 2012, 2012: 965159. DOI: 10.1155/2012/965159.
[37]
Kneyber M, de Luca D, Calderini E, et al. Recommendations for mechanical ventilation of critically ill children from the Paediatric Mechanical Ventilation Consensus Conference (PEMVECC) [J]. Intensive Care Med, 2017, 43(12): 1764-1780. DOI: 10.1007/s00134-017-4920-z.
[38]
Pandita A, Murki S, Oleti TP, et al. Effect of nasal continuous positive airway pressure on infants with meconium aspiration syndrome: a randomized clinical trial [J]. JAMA Pediatr, 2018, 172(2): 161-165. DOI: 10.1001/jamapediatrics.2017.3873.
[39]
Manandhar SR. Outcome of respiratory distress in neonates with bubble CPAP at neonatal intensive care unit of a tertiary hospital [J]. JNMA J Nepal Med Assoc, 2019, 57(216): 92-97. DOI: 10.31729/jnma.4294.
[40]
Mathai SS, Rajeev A, Adhikari KM. Safety and effectiveness of bubble continuous positive airway pressure in preterm neonates with respiratory distress [J]. Med J Armed Forces India, 2014, 70(4): 327-331. DOI: 10.1016/j.mjafi.2013.08.003.
[41]
Sharma S, Clark S, Abubakar K, et al. Tidal volume requirement in mechanically ventilated infants with meconium aspiration syndrome [J]. Am J Perinatol, 2015, 32(10): 916-919. DOI: 10.1055/s-0034-1396698.
[42]
Lindenskov PH, Castellheim A, Saugstad OD, et al. Meconium aspiration syndrome: possible pathophysiological mechanisms and future potential therapies [J]. Neonatology, 2015, 107(3): 225-230. DOI: 10.1159/000369373.
[43]
Konduri GG, Sokol GM, Van Meurs KP, et al. Impact of early surfactant and inhaled nitric oxide therapies on outcomes in term/late preterm neonates with moderate hypoxic respiratory failure [J]. J Perinatol, 2013, 33(12): 944-949. DOI: 10.1038/jp.2013.83.
[44]
Fichera D, Zanella F, Fabozzo A, et al. HandS ECMO: preliminary experience with " Hub and Spoke" model in neonates with meconium aspiration syndrome [J]. Artif Organs, 2019, 43(1): 76-80. DOI: 10.1111/aor.13270.
[45]
Paden ML, Rycus PT, Thiagarajan RR, et al. Update and outcomes in extracorporeal life support [J]. Semin Perinatol, 2014, 38(2): 65-70. DOI: 10.1053/j.semperi.2013.11.002.
[46]
De Luca D, Tingay DG, van Kaam A, et al. Hypothermia and meconium aspiration syndrome: international multicenter retrospective cohort study [J]. Am J Respir Crit Care Med, 2016, 194(3): 381-384. DOI: 10.1164/rccm.201602-0422LE.
[47]
De Luca D, Vázquez-Sánchez S, Minucci A, et al. Effect of whole body hypothermia on inflammation and surfactant function in asphyxiated neonates [J]. Eur Respir J, 2014, 44(6): 1708-1710. DOI: 10.1183/09031936.00117714.
[48]
Autilio C, Echaide M, De Luca D, et al. Controlled hypothermia may improve surfactant function in asphyxiated neonates with or without meconium aspiration syndrome [J]. PLoS One, 2018, 13(2): e0192295. DOI: 10.1371/journal.pone.0192295.
[49]
Choi W, Jeong H, Choi SJ, et al. Risk factors differentiating mild/moderate from severe meconium aspiration syndrome in meconium-stained neonates [J]. Obstet Gynecol Sci, 2015, 58(1): 24-31. DOI: 10.5468/ogs.2015.58.1.24.
[50]
Oliveira CPL, Flôr-de-Lima F, Rocha GMD, et al. Meconium aspiration syndrome: risk factors and predictors of severity [J]. J Matern Fetal Neonatal Med, 2019, 32(9): 1492-1498. DOI: 10.1080/14767058.2017.1410700.
[51]
Louis D, Sundaram V, Mukhopadhyay K, et al. Predictors of mortality in neonates with meconium aspiration syndrome [J]. Indian Pediatr, 2014, 51(8): 637-640. DOI: 10.1007/s13312-014-0466-0.
[52]
Narayanan A, Batra P, Faridi M, et al. PaO2/FiO2 ratio as predictor of mortality in neonates with meconium aspiration syndrome[J]. Am J Perinatol, 2019, 36(6): 609-614. DOI: 10.1055/s-0038-1672171.
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