Chinese Medical E-ournals Database

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2020, Vol. 16 ›› Issue (03): 249 -256. doi: 10.3877/cma.j.issn.1673-5250.2020.03.001

Special Issue:

Healthy People, Healthy Society

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)

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.

[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.
[1] Qiuyang Zhang, Shaoyun Yu, Xiangying Pan, Jiajia Jin, Hua Xia, Xuehong Zhao. Risk factors for hemorrhage in adult patients with extracorporeal membrane oxygenation:a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2024, 17(05): 392-398.
[2] Liang Liang, Zheng Tan, Ting Huang, Yue Gao, Jian Zhang, Jie Xia. Risk factors of postoperative respiratory support in newborns with congenital diaphragmatic hernia[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2024, 20(01): 9-17.
[3] Feng Huo, Zhixia Li, Ru Ji, Xiaoyu Tan, Xiaoli Fan, Qifa Ye. Classification, implementation process, and considerations for donation after circulatory determination of death[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(04): 213-221.
[4] Branch of Organ Transplantation of Chinese Medical Association. Guideline on the application of extracorporeal membrane oxygenation in the protection of deceased donor kidneys[J]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(03): 148-158.
[5] Ding Wei, Yanyan Qiao, Xing Gu, Yan Zhang, Yanyan Li, Weisheng Qian, Lei Pan, Yongheng Gao, Faguang Jin. Risk factors of poor prognosis after extracorporeal membrane oxygenation in acute respiratory distress syndrome patients[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(03): 363-367.
[6] Xiaoxia Wang, Dan Wu, Jiangying Zhang, Yahan Wu, Yingnan Hao. Interpretation of an update on clinical practice guideline of adult patients with acute respiratory distress syndrome of American Thoracic Society[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(04): 338-343.
[7] Shuai Zhou, Qinghai Zhang, Xin Wang, Xiaoyan Ma, Jianxia Sun, Haibo Wang, Jihong Zhang. Venous arterial extracorporeal oxygenation assisted thrombolysis in one case of acute high-risk pulmonary embolism[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(03): 298-302.
[8] Hao Xu, Liang Luo. Research progress in hospital acquired infections of ECMO patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(03): 292-297.
[9] Yin Zhang, Guoqiang Li. Treatment of septic shock with methylene blue[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(02): 143-147.
[10] Wenzhe Li, Pengfei Pan, Jian Cui, Xiangyou Yu. Ethical issues in the clinical application of extracorporeal life support[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2024, 10(02): 97-101.
[11] Ke Fang, Huanhuan Da, Jun Wang, Ruixiang Sun, Tao Wang, Yang Li, Haijiao Jiang, Weihua Lu. ECMO assisted adrenal excision for pheochromocytoma catecholamine cardiomyopathy during pregnancy: a case report and literature review[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(03): 304-310.
[12] Liang Liu, Hao Xiao, Xiaolei Cui, Baopu Lv, Rui Zhang, Tuokang Zheng, Qingbing Meng, Dongqi Yao, Yingping Tian, Hengbo Gao. Prognostic factors in patients with acute myocardial infarction combined with cardiogenic shock: analysis of 97 cases[J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(02): 183-189.
[13] Mingjie Zhang, Liping Liu, Chunxiang Li, Yujie Liu, Zhuoming Xu. Efficacy and safety of early nitric oxide inhalation therapy after congenital heart surgery[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(04): 210-215.
[14] Yongna Feng, Jian Ye. The value of exhaled nitric oxide detection in the diagnosis of asthma-chronic obstructive pulmonary diseases overlap in the elderly[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2024, 11(01): 30-34.
[15] Weiqiang Zhan, Mengdie Li, Yulin Tu, Yan Guo, Yibin Lu, Xinge Shi, Ming Xu. Clinical Effects of Early CRRT Combined with VA-ECMO in the Treatment of Refractory Cardiogenic Shock[J]. Chinese Journal of Hygiene Rescue(Electronic Edition), 2024, 10(05): 260-268.
Viewed
Full text


Abstract