Glucocorticoids in the treatment of neonatal meconium aspiration syndrome

Abstract

Meconium aspiration syndrome is a serious neonatal disease with complex pathophysiology. With respect to the contribution of meconium-induced lung edema, inflammation and vasoconstriction on the course of the disease, glucocorticoids are increasingly used in the treatment of MAS despite the fact that principal questions on the choice of GCs derivative, mode of delivery and dosing have not been answered yet. To bring a complex insight into the topic, this article reviews the pathomechanisms of MAS, mechanisms of action of GCs, as well as the advantages and disadvantages of GCs administration in experimental models and newborns with MAS.

Advances in Neonatal Pulmonary Hypertension

“…Hydrocortisone also increased cGMP by normalizing sGC and PDE5 activity and by attenuating abnormalities induced by oxidative stress [18]. Brief courses of glucocorticoids may be beneficial, particularly in severe MAS in the presence of lung edema, pulmonary vasoconstriction and inflammation [71]. However, the usual precautions must be exercised when considering steroids in neonates.…”

Dexamethasone and outcome of meconium aspiration syndrome: Vijayapur, Karnataka experience

“…Budesonide used with high frequency jet ventilation was found to be better with minimal extra-pulmonary losses 4 . Tripathi et al 1,5 reported better oxygenation and reduced hospital stay with intra-tracheal budesonide.…”

“…The main advantage with budesonide was the route of administration. It was administered through intratracheal route in rabbits and effects were much better and it alleviated side effects noticed by systemic dexamethasone, like heart rate variability with reduction of oxidation injury to lungs 4,8 . Basu et al in their trial on newborns, used nebulized budesonide and compared it with systemic methylprednisolone and control group (no steroid group) of newborns and found steroids useful with no toxic effects irrespective of route of administration 2 .…”

“…Early administration of dexamethasone can be tried in newborn with MAS with severe distress and obvious radiological findings. Premedication with steroids before delivery is also suggested though so far it has not been tried 4 . In our subjects among the intervention group, 4 neonates needed ventilatory support (p <0.05).…”

“…The synthetic glucocorticoid dexamethasone has metabolic and anti-inflammatory effects. Its anti-inflammatory action results from inhibition of transcription factors and inhibition of the expression of proinflammatory cytokines, enzymes and other biologically active substances 2,4 . Dexamethasone, by direct modulation of pulmonary vasomotor tone, diminishes pulmonary vasoconstriction which is responsible for pulmonary hypertension and inhibits fibrogenesis 5 .…”