Surfactant Therapy's Impact on Meconium Aspiration Syndrome in Resource-Limited Settings:

Author(s): Pratheek Choppala M.D*, Sai Sanjana Jalagadugula M.D, Vivek Peddakota M.B.B.S, Harikrishna Enapothula M.B.B.S, Yashwanth Katlagunta M.B.B.S, Siddharth Sai M.B.B.S, Swamy Naidu M.D DCH, MRCPCH

Purpose: Meconium aspiration syndrome (MAS) is concerning for term infants, with surfactant therapy as an adjunct. However, its efficacy is varied, especially in resource-limited areas. This study addresses surfactant's impact on MAS mortality and morbidity rates in low-middle-income settings, aiming to optimize resource allocation and cost-effectiveness amidst challenges like expensive treatment and limited access to advanced interventions like ECMO and iNO therapy in India.

Methods: This hospital-based observational study examined surfactant bolus effects in the Neonatal Intensive Care Unit (NICU) at King George Hospital, Visakhapatnam, from January 2020 to July 2021. It involved 64 neonates divided into 32 cases and 32 controls. Control neonates were chosen from prior patients treated following established guidelines, including empirical antibiotics administration between January 2019 and December 2019.

Results: The mean duration of surfactant administration since birth is 13.67 hrs. (Range: 4.6 to 23), yielding reduction in oxygenation index (P=0.008) and pao2/pAo2 (P=0.005) at 24 hours Mortality rate: surfactant group 9.38% (3/32), standard care 15.63% (5/32), not statistically significant (P=0.449). Surfactant group showcased a remarkable 4.8-day reduction in hospital stay duration (P=0.0001). Similarly, surfactant-treated neonates demonstrated shorter mechanical ventilation by 3.3 days (P=0.0004), and oxygen therapy duration reduced by 1.7 days (P = 0.001).

Conclusion: Our study indicates that adjunctive surfactant administration can alleviate financial strain by notably shortening hospital stays, mechanical ventilation, and oxygen therapy in resource-limited settings. This suggests potential benefits for government policies in terms of cost reduction and healthcare burden. These findings also offer insights for future research, particularly regarding optimal timing of surfactant intervention in the context of Meconium Aspiration Syndrome (MAS).

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