Management of meconium aspiration syndrome

Meconium aspiration syndrome (MAS) mainly affects term and post-term infants. It ranges from mild respiratory distress to life-threatening cardiorespiratory failure. Prevention and treatment strategies are evolving. Amnioinfusion is no longer recommended for women with meconium staining of the amniotic fluid (MSAF). Pharyngeal suction prior to delivery of the fetal shoulders and tracheal suction of vigorous infants after birth do not prevent MAS and may be harmful. Tracheal suction is recommended for non-vigorous infants with MSAF but has not been studied prospectively. Bolus surfactant therapy, high frequency oscillatory ventilation and inhaled nitric oxide may be beneficial in severe cases. Surfactant lavage reduces the combined risk of death or requirement for extracorporeal membrane oxygenation (ECMO) when compared with no surfactant treatment but its role in the routine management of MAS is uncertain and it should be compared with bolus surfactant in prospective studies. ECMO reduces the risk of mortality in severe cases so it is of paramount importance to discuss the transfer of severely ill infants to an ECMO centre.