Efficacy of Bolus Surfactant Therapy in Neonates with Meconium Aspiration Syndrome: A Prospective Controlled Study

Abstract Background: Meconium aspiration syndrome (MAS) is a major cause of respiratory distress in neonates. One contributing mechanism is meconium-induced impairment of surfactant function, which increases surface tension and makes alveoli more prone to collapse. This supports the rationale for bolus surfactant therapy. Methods: This prospective controlled study at Shri Dada Dev Matri Avum Shishu Chikitsalaya, New Delhi, was conducted from January to December 2019. The study included 60 neonates with MAS, 30 in each group. The intervention group received a single surfactant bolus in addition to standard care, whereas controls received standard care alone. We compared respiratory parameters, duration of respiratory support, and hospital stay between groups. Results: Neonates receiving surfactant had greater improvement in arterial oxygenation and lower oxygen requirements than controls. The mean duration of mechanical ventilation was shorter in the surfactant group (0.53 ± 1.01 versus 1.10 ± 1.21 days; p = 0.042), as were the durations of continuous positive airway pressure (2.70 ± 1.99 versus 3.77 ± 0.97 days; p < 0.001) and oxygen therapy (4.33 ± 2.25 versus 6.73 ± 1.34 days; p < 0.001). The mean hospital stay was 6.50 ± 2.66 days in the surfactant group, compared with 11.83 ± 2.21 days in controls (p < 0.001). Conclusion: A single surfactant bolus was associated with improved oxygenation, shorter durations of respiratory support, and reduced hospital stay in neonates with MAS. These findings are relevant to neonatal units with limited resources. Keywords: Meconium aspiration syndrome; pulmonary surfactants; newborn; oxygen therapy; mechanical ventilation; hospital stay