Meconium Aspiration Syndrome Medication

Updated: Mar 20, 2017
  • Author: Gina M Geis, MD; Chief Editor: Ted Rosenkrantz, MD  more...
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Medication

Medication Summary

In addition to the treatments discussed earlier and the medications listed below, surfactant replacement therapy is frequently used in infants with meconium aspiration syndrome (MAS). Natural lung extract is administered to replace the surfactant that has been stripped. Surfactant also acts as a detergent to break up residual meconium, thereby decreasing the severity of lung disease. Surfactant is used in patients with MAS; however, its efficacy, dosage regimen, and most effective product are not yet established.

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Respiratory gases

Class Summary

Inhaled nitric oxide (NO) has the direct effect of pulmonary vasodilatation without the adverse effect of systemic hypotension. It is approved for use, if concomitant hypoxemic respiratory failure occurs.

Nitric oxide, inhaled

Endogenously produced from the action of the enzyme NO synthetase on arginine. Exogenously inhaled NO is used in an attempt to decrease pulmonary vascular resistance and improve lung blood flow. It relaxes vascular smooth muscle by binding to the heme moiety of cytosolic guanylate cyclase, activating guanylate cyclase and increasing intracellular levels of cGMP, which then leads to vasodilation.

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Systemic vasoconstrictors

Class Summary

These agents are used to prevent right-to-left shunting by raising systemic pressure above pulmonary pressure. Systemic vasoconstrictors include dopamine, dobutamine, and epinephrine. Dopamine is the most commonly used.

Dopamine

At lower doses, dopamine stimulates beta1-adrenergic and dopaminergic receptors (renal vasodilation, positive inotropism); at higher doses, it stimulates alpha-adrenergic receptors (renal vasoconstriction).

Dobutamine

Increases blood pressure primarily via stimulation of beta1-adrenergic receptors. This drug appears to have a more prominent effect on cardiac output than on blood pressure.

Epinephrine

Used for severe bronchoconstriction, especially in patients with underlying reactive airway disease. Alpha-agonist effects include increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability. Beta2-agonist effects include bronchodilatation, chronotropic cardiac activity, and positive inotropic effects.

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Sedatives

Class Summary

These agents maximize efficiency of mechanical ventilation, minimize oxygen consumption, and treat the discomfort of invasive therapies. However, some controversy exists around the unknown long-term effect(s) of analgesics and sedatives on the developing brain.

Morphine

Used for analgesia and sedation.

Fentanyl

Potent opioid used for analgesia, sedation, and anesthesia. Has a shorter duration of action than morphine.

Phenobarbital

An anticonvulsant that may be used as a sedative. Suppresses the CNS from the reticular activating system (ie, presynaptic, postsynaptic).

Phenobarbital remains a first-line therapy for neonatal seizures, which may occur in the setting of perinatal depression.

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Neuromuscular blocking agents

Class Summary

These agents are used for skeletal muscle paralysis to maximize ventilation by improving oxygenation and ventilation. They are also used to reduce barotrauma and minimize oxygen consumption.

The use of paralytics remains controversial and should be considered in newborns whose management with sedatives alone is failing.

Pancuronium or vecuronium

Neuromuscular blocker whose effects are reversed by neostigmine and atropine.

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