Janette Dvorská, Katarína Maťašová
Meconium aspiration syndrome (MAS) is a life-threatening condition in the newborn. Preventive measures in the past with the aim to reduce the incidence and severity of the disease included mostly mechanical cleaning of the airways. A routine intrapartum suction of mouth and nose in children with meconium stained amniotic fluid (MSAF) and postnatal suction of lower respiratory tract in all newborns were recommended. Both procedures have been challenged by randomized controlled trials (RCTs). Endotracheal intubation and suction are currently recommended only in infants with symptoms of postpartum depression. Respiratory failure in infants with MAS is often initially resolved by conventional or synchronized mechanical ventilation. Surfactant administration and high frequency ventilation (HFV) are commonly used as a rescue therapy in severe cases. Nitric oxide (NO) is indicated in patients with a severe pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) is the last possibility in those cases where other treatment modalities have failed. In the pathophysiology of severe MAS are asphyxia and pulmonary hypertension considered to be more important than airway obstruction and/or lung damage caused by meconium.