Korean Journal of Pediatrics 2009;52(4):429-434.
Published online April 15, 2009.
Clinical findings of severe amniotic fluid aspiration pneumonia and effects of surfactant replacement therapy
Sang Woo Park, Chun-Soo Kim, Sang-Lak Lee, Tae-Chan Kwon
Department of Pediatrics, Keimyung University School of Medicine, Daegu, Korea
중증 양수 흡인성 폐렴의 임상양상 및 폐표면 활성제 보충요법의 효과
박상우, 김천수, 이상락, 권태찬
계명대학교 의과대학 소아과학교실
Correspondence: 
Chun-Soo Kim, Email: cskim@dsmc.or.kr
Abstract
Purpose
: Severe aspiration of the amniotic fluid is known to cause fatal respiratory distress in neonates. We conducted this study to investigate the clinical findings of severe amniotic fluid aspiration pneumonia (AFAP) in neonates and the effect of pulmonary surfactant replacement therapy (SRT).
Methods
: Retrospective analysis of medical records was conducted on 28 patients who received ventilator care due to severe AFAP in a neonatal intensive care unit over a 7-year period (2000-2006). Patients whose amniotic fluid was contaminated with meconium were excluded.
Results
: A large number of cases were term infants (82.1%) and infants born by caesarean section (85.7%), and the 1- and 5-min Apgar scores of these patients were 6.5¡¾1.2 and 7.5¡¾1.3, respectively. Soon after birth, the amount of amniotic fluid sucked out from airway below the vocal cord was 16.0¡¾10.1 mL. All patients received SRT with a modified bovine-derived surfactant (120 mg/kg/dose), and one dose was administered in most cases (75%). Compared with pre-SRT, the oxygenation index (8.0¡¾9.6 vs. 18.9¡¾7.3) according to ventilator care was a significant improvement at 12 h after SRT (P<0.001). Furthermore, most cases showed radiological improvement for aeration at 12 h post-treatment. Many cases (46.4%) had cardiorespiratory complications, but their final outcomes were excellent (survival rate, 96.4%).
Conclusion
: AFAP may be an important cause of serious respiratory distress in near-term and term infants, and SRT seems to be an effective adjuvant therapy in mechanically ventilated neonates with severe AFAP.
Key Words: Amniotic Fluid, Aspiration Pneumonia, Pulmonary Surfactant


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