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El síndrome de aspiración meconial, es una condición clínica caracterizada por insuficiencia respiratoria que ocurre en neonatos nacidos a través de líquido amniótico teñido de meconio, y que puede presentarse como una enfermedad grave con riesgo vital. Su incidencia ha disminuido gracias a mejores prácticas obstétricas y atención perinatal y se ha observado una mejoría en la sobrevida, gracias a mejores prácticas en la UCI neonatal. Sin embargo, el abordaje más adecuado sigue siendo un tema de debate, dado que hasta el momento se basa sólo en medidas de soporte, sin que existan medidas que actúen sobre los mecanismos de daño. Por otro lado, la morbilidad a largo plazo entre los sobrevivientes sigue siendo una preocupación importante. Esta revisión ofrece una visión general actualizada de la epidemiología, la fisiopatología, el diagnóstico, el manejo terapéutico, la prevención y el pronóstico de los pacientes que presentan este cuadro.

Meconium aspiration syndrome is a clinical condition characterized by respiratory failure that occurs in neonates born through meconium-stained amniotic fluid and can present as a serious life-threatening disease. Its incidence has decreased thanks to better obstetric practices and perinatal care, and an improvement in survival has been observed, thanks to better practices in the neonatal ICU. However, the most appropriate approach is still a matter of debate, given that so far it is based only on support measures, without any measures that act on the damage mechanisms. On the other hand, long-term morbidity among survivors remains a major concern. This review offers an updated overview of the epidemiology, pathophysiology, diagnosis, therapeutic management, prevention, and prognosis of patients with this condition.

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OBJECTIVE: To assess whether endotracheal suctioning of nonvigorous infants born through meconium stained amniotic fluid (MSAF) reduces the risk and complications of meconium aspiration syndrome (MAS). STUDY DESIGN: Term, nonvigorous babies born through MSAF were randomized to endotracheal suction and no-suction groups (n=61 in each). Risk of MAS, complications of MAS and endotracheal suction, mortality, duration of neonatal intensive care unit stay, and neurodevelopmental outcome at 9 months were assessed. RESULTS: Maternal age, consistency of meconium, mode of delivery, birth weight, sex, and Apgar scores were similar in the groups. In total, 39 (32%) neonates developed MAS and 18 (14.8%) of them died. There were no significant differences in MAS, its severity and complications, mortality, and neurodevelopmental outcome for the 2 groups. One infant had a complication of endotracheal suctioning, which was mild and transient. CONCLUSIONS: The current practice of routine endotracheal suctioning for nonvigorous neonates born through MSAF should be further evaluated. TRIAL REGISTRATION: Clinical Trial Registry of India: CTRI/2013/03/003469.

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Meconium aspiration syndrome (MAS) is a life threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Its obstetric and perinatal management has been changing for over 35 years. In pregnancies complicated by MSAF, suction of the hypopharynx before the delivery of the infant's shoulders and postnatal suction of vigorous infants have been used in an effort to clear the airway and decrease the incidence and the severity of the disease. Based on the results of two large RCTs, international guidelines from scientific societies for intrapartum and postpartum management of pregnancies with MSAF have radically changed. Intrapartum suction and postnatal intubation and suction of vigorous infants are not longer recommended. For depressed infants there are no randomized trials to support or to refute this practice. Other non recommended manoeuvres such as thorax compression and gastric lavage are still sometimes performed. The adherence to norms and recommendations is not uniform. Neonatologists should make efforts to get the new evidence more quickly move to evidence-based clinical practice.

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Meconium aspiration syndrome (MAS) is a life-threatening disorder in newborn infants. Universal intrapartum suction of infants with meconium stained amniotic fluid (MSAF) and postnatal suction of vigorous infants have been used in an attempt to decrease the incidence and severity of the disease by clearing the airway. Both procedures have been proven fruitless when challenged through randomised control trials (RCTs). Endotracheal intubation and suctioning are currently recommended only for non-vigorous infants. Respiratory failure in infants with MAS is frequently treated initially with conventional or synchronized mechanical ventilation. Surfactant administration and high-frequency ventilation (HFV) are commonly used as rescue therapy for severe cases. Nitric oxide (NO) is added when severe pulmonary hypertension is demonstrated. ECMO is an option when other treatments have failed. In the pathophysiology of severe MAS, asphyxia and pulmonary hypertension are considered to be more important than the obstruction of the airways and/or damage to the lung produced by meconium.

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BACKGROUND: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. METHODS: We designed a randomised controlled trial in 11 hospitals in Argentina and one in the USA. 2514 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=1263), or no suctioning before delivery (n=1251). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used. Analysis was by intention to treat. FINDINGS: 18 infants in the suction group and 15 in the no suction group did not meet entry criteria after random assignment. 87 in the suction group were not suctioned, and 26 in the no suction group were suctioned. No significant difference between treatment groups was seen in the incidence of MAS (52 [4%] suction vs 47 [4%] no suction; relative risk 0.9, 95% CI 0.6-1.3), need for mechanical ventilation for MAS (24 [2%] vs 18 [1%]; 0.8, 0.4-1.4), mortality (9 [1%] vs 4 [0.3%]; 0.4, 0.1-1.5), or in the duration of ventilation, oxygen treatment, and hospital care. INTERPRETATION: Routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation infants born through MSAF does not prevent MAS. Consideration should be given to revision of present recommendations.

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Objetivo. Determinar la utilidad de la intubación endotraqueal y aspiración directa a tráquea para disminuir la incidencia de síndrome de aspiración meconial en recién nacidos sanos y vigorosos nacidos con líquido amniótico meconial y conocer las complicaciones del procedimiento. Diseño. Estudio de cohortes concurrentes sin asignación aleatoria. Unidades de estudio. Ciento cincuenta y uno recién nacidos con peso igual o mayor de 2,500 g, nacidos con líquido amniótico meconial de cualquier densidad, con Apgar igual o mayor de 7 al minuto de vida y clínicamente sanos. Mediciones y resultados. Se dividieron a los pacientes en dos grupos. A todos los pacientes se les realizó aspiración nasofaríngea al momento de nacer la cabeza y antes del nacimiento completo. Al grupo 1 (n=88) no se realizó ningún procedimiento y al grupo 2 (n=63) se realizó laringoscopia para la visualización y aspiración directa a tráquea posterior al nacimiento. No se presentó ningún caso de SAM. ningún paciente del grupo 1 presentó complicaciones y dos pacientes del grupo dos presentaron complicaciones pulmonares. Conclusiones. Las maniobras de laringoscopia y aspiración traqueal no están indicadas como procedimiento de rutina en pacientes sanos y vigorosos con líquido amniótico meconial, ya que existe mayor riesgo de complicación

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