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Licensed Unlicensed Requires Authentication Published by De Gruyter February 20, 2015

Surfactant with and without bronchoalveolar lavage in an experimental model of meconium aspiration syndrome

  • Roseli Henn , Renato Machado Fiori EMAIL logo , Humberto Holmer Fiori , Manuel Ruttkay Pereira , Maurício Obal Colvero , Pedro Celiny Ramos Garcia , Priscila Padoim and Jaqueline Basso Stivanin



To assess the effect of surfactant administration, preceded or not by bronchoalveolar lavage (BAL) with dilute surfactant, on pulmonary function in experimental severe meconium aspiration syndrome.


Twenty-one newborn pigs received 20% meconium in saline intratracheally and were randomly allocated to one of three groups: I, control; II, surfactant only (poractant alfa, 200 mg/kg); or III, dilute surfactant BAL followed by 125 mg/kg surfactant. Arterial blood gases (ABGs), lung compliance, and resistance were assessed.


Thirty minutes after treatment, mean PaO2 (mm Hg) increased to 72 in group I, to 106 in group II and to 172 in group III (P=0.01). After 3 h, mean PaO2 (mm Hg) was 70 in group I, 95 in group II and 198 in group III (P<0.01). After 6 h, it was 79 in group I, 110 in group II, and 217 in group III (P=0.01). From the 30-min point onward, there were significant differences among treatment groups in all other parameters and at every point of assessment, except for compliance and resistance 3 h after treatment.


BAL with dilute surfactant, followed by an additional dose of surfactant, produced significant improvements in ABGs and pulmonary mechanics as compared with a single dose of surfactant.

Corresponding author: Renato Machado Fiori, Hospital São Lucas da PUCRS, Porto Alegre - RS, Brazil, Tel.: +55-51-3315-4188, E-mail: ; and Graduate Program in Medicine – Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre – RS, Brazil


[1] Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am. 1998;45:511–29.10.1016/S0031-3955(05)70025-0Search in Google Scholar

[2] Guinsburg RAM, Moreira LMO, Santos RMV, Anchieta LM, Daripa M. Mortalidade neonatal precoce por síndrome de aspiração de mecônio: Brasil 2005 a 2007. 4° Simpósio Internacional de Reanimação Neonatal; 2011.Search in Google Scholar

[3] Sun B, Curstedt T, Robertson B. Surfactant inhibition in experimental meconium aspiration. Acta Paediatr. 1993;82:182–9.10.1111/j.1651-2227.1993.tb12635.xSearch in Google Scholar PubMed

[4] Findlay RD, Taeusch HW, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics. 1996;97:48–52.10.1542/peds.97.1.48Search in Google Scholar

[5] Halliday HL, Speer CP, Robertson B. Treatment of severe meconium aspiration syndrome with porcine surfactant. Collaborative Surfactant Study Group. Eur J Pediatr. 1996;155:1047–51.10.1007/BF02532529Search in Google Scholar PubMed

[6] Cochrane CG, Revak SD, Merritt TA, Schraufstatter IU, Hoch RC, Henderson C, et al. Bronchoalveolar lavage with KL4-surfactant in models of meconium aspiration syndrome. Pediatr Res. 1998;44:705–15.10.1203/00006450-199811000-00013Search in Google Scholar PubMed

[7] Colvero MO, Fiori HH, Fiori RM, Luz JH, de Paula D, Oppermann C, et al. Bronchoalveolar lavage plus surfactant in a piglet model of meconium aspiration syndrome. Neonatology. 2008;93:188–92.10.1159/000110866Search in Google Scholar PubMed

[8] Dargaville PA, Copnell B, Mills JF, Haron I, Lee JK, Tingay DG, et al. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. J Pediatr. 2011;158:383–9 e2.10.1016/j.jpeds.2010.08.044Search in Google Scholar PubMed

[9] Dargaville PA, Mills JF, Headley BM, Chan Y, Coleman L, Loughnan PM, et al. Therapeutic lung lavage in the piglet model of meconium aspiration syndrome. Am J Respir Crit Care Med. 2003;168:456–63.10.1164/rccm.200301-121OCSearch in Google Scholar PubMed

[10] Lam BC, Yeung CY. Surfactant lavage for meconium aspiration syndrome: a pilot study. Pediatrics. 1999;103:1014–8.10.1542/peds.103.5.1014Search in Google Scholar PubMed

[11] Lista G, Bianchi S, Castoldi F, Fontana P, Cavigioli F. Bronchoalveolar lavage with diluted porcine surfactant in mechanically ventilated term infants with meconium aspiration syndrome. Clin Drug Investig. 2006;26:13–9.10.2165/00044011-200626010-00002Search in Google Scholar PubMed

[12] Moller JC, Kohl M, Reiss II, Diederich W, Nitsche EM, Gopel W, et al. Saline lavage with substitution of bovine surfactant in term neonates with meconium aspiration syndrome (MAS) transferred for extracorporeal membrane oxygenation (ECMO): a pilot study. Crit Care. 1999;3:19–22.10.1186/cc302Search in Google Scholar

[13] Mosca F, Colnaghi M, Castoldi F. Lung lavage with a saline volume similar to functional residual capacity followed by surfactant administration in newborns with severe meconium aspiration syndrome. Intensive Care Med. 1996;22:1412–3.10.1007/BF01709561Search in Google Scholar

[14] Paranka MS, Walsh WF, Stancombe BB. Surfactant lavage in a piglet model of meconium aspiration syndrome. Pediatr Res. 1992;31:625–8.10.1203/00006450-199206000-00017Search in Google Scholar

[15] Rey-Santano C, Alvarez-Diaz FJ, Mielgo V, Murgia X, Lafuente H, Ruiz-Del-Yerro E, et al. Bronchoalveolar lavage versus bolus administration of lucinactant, a synthetic surfactant in meconium aspiration in newborn lambs. Pediatr Pulmonol. 2011;46:991–9.10.1002/ppul.21460Search in Google Scholar

[16] Salvia-Roiges MD, Carbonell-Estrany X, Figueras-Aloy J, Rodriguez-Miguelez JM. Efficacy of three treatment schedules in severe meconium aspiration syndrome. Acta Paediatr. 2004;93:60–5.10.1111/j.1651-2227.2004.tb00675.xSearch in Google Scholar

[17] Szymankiewicz M, Gadzinowski J, Kowalska K. Pulmonary function after surfactant lung lavage followed by surfactant administration in infants with severe meconium aspiration syndrome. J Matern Fetal Neonatal Med. 2004;16:125–30.10.1080/jmf. in Google Scholar

[18] Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H, Walsh WF, et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics. 2002;109:1081–7.10.1542/peds.109.6.1081Search in Google Scholar

[19] Colvero MO, Fiori HH, Luz JH, Pereira MR, Fiori AH, Silveira C. Surfactant treatment in an experimental model of meconium aspiration syndrome. 24th International Workshop on Surfactant Replacement; 2009. Ljubljana, Slovenia.Search in Google Scholar

[20] Pereira M, Fiori H, Luz J, Colvero M, Fiori A, Bisinela F. Early versus late administration of bronchoalveolar lavage with diluted surfactant followed by a supplementary dose of surfactant in an experimental model of meconium aspiration syndrome. PAS/ASPR Joint Meeting, poster session: neonatal pulmonology; 2011. Denver, CO.Search in Google Scholar

[21] El Shahed AI, Dargaville P, Ohlsson A, Soll RF. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev. 2007;CD002054.10.1002/14651858.CD002054.pub2Search in Google Scholar

[22] Lin XZ, Lai JD, Lan ZY, Lin YY. [Clinical effect of endotracheal lavage with porcine pulmonary surfactant in term neonates with severe meconium aspiration syndrome]. Zhongguo Dang Dai Er Ke Za Zhi. 2014;16:709–13.Search in Google Scholar

[23] Ohama Y, Ogawa Y. Treatment of meconium aspiration syndrome with surfactant lavage in an experimental rabbit model. Pediatr Pulmonol. 1999;28:18–23.10.1002/(SICI)1099-0496(199907)28:1<18::AID-PPUL4>3.0.CO;2-OSearch in Google Scholar

[24] Dargaville PA, Mills JF, Copnell B, Loughnan PM, McDougall PN, Morley CJ. Therapeutic lung lavage in meconium aspiration syndrome: a preliminary report. J Paediatr Child Health. 2007;43:539–45.10.1111/j.1440-1754.2007.01130.xSearch in Google Scholar

[25] Jeng MJ, Soong WJ, Lee YS. Effective lavage volume of diluted surfactant improves the outcome of meconium aspiration syndrome in newborn piglets. Pediatr Res. 2009;66:107–12.10.1203/PDR.0b013e3181a29092Search in Google Scholar PubMed

The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2014-8-26
Accepted: 2015-1-12
Published Online: 2015-2-20
Published in Print: 2016-8-1

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