Meconium aspiration syndrome: clinical profile, risk factors and outcome in central India
Keywords:APGAR score, Amniotic fluid, Meconium aspiration syndrome, Primigravida, Risk factors
Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disease affecting some neonates born through meconium-stained amniotic fluid (MSAF). MSAF complicates delivery in approximately 8% to 25% of live births, of which nearly 5% of the neonates born through MSAF develop MAS. The present study was undertaken to find out the prevalence of MSAF and MAS and to study the etiology, risk factors, clinical profile and outcome of MAS.
Methods: By purposive sampling technique, all newborns, fulfilling the inclusion criteria during one year of study period were enrolled in this hospital based cross-sectional observational study. Risk factors and clinical profile were compared between those who died and survived.
Results: Out of 8765 deliveries in hospital 1220 neonates were born with MSAF of which 94 neonates had MAS. Thereby, incidence of MSAF was 13.9% and incidence of MAS out of MSAF was 7.7 %. Of the 94 neonates who had MAS 13.82% died. Almost 3/4th of the MAS neonates were term and AGA. MAS were more common in primigravida mother (68%) and LSCS deliveries (53.2%). Of the total MAS 54.2% had thick meconium in whom mortality was 92.3%. The mortality in MAS cases was significant in low 5-minute APGAR score and non-vigorous baby.
Conclusions: Since MSAF is associated with higher morbidity and mortality, if the knowledge of risk factors is known to health care personnel then timely referral or intervention can help in decreasing MAS and its complications.
Harries JT. Meconium in Health and Disease. Br Med Bull. 1978;34(1):75-8.
Burris HH. Meconium Aspiration. In:Cloherty JP et al. (eds.) Manual of neonatal Care.7th edition, Philadelphia: Lippincott Williams and Wilkins, A Wolters Kluwer business ; 2012. p. 429-434.
Greenough A, Milner A.D. Pulmonary Diseases of New-born. In: Renne, JM et al. Textbook of Neonatology.4th edition. Churchill living stone;2006; p199,502-508
Sedaghatian MR, Othman L, Rashid N, Ramachandran P; Bener AB. An 8-Year Study of Meconium Stained Amniotic Fluid in Different Ethnic Groups. Kuwait Med J. 2004; 36(4):266-9.
Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes. Indian Pediatr. 1996;33(4):293-8.
Narang A. Definition of major illnesses as applicable at different levels of the health care delivery system. InNeonatal Nomenclature and Data Collection. New Delhi, National Neonatology Forum 1989 (pp. 27-35).
Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediat Clinic North Am. 1998;45(3):511-29.
Eregie CS. A new method for maturity determination in newborn infants. J Trop Pediat. 2000;46(3):140-4.
Konduri GG, Kim UO. Advances in the diagnosis and management of persistent pulmonary hypertension of the newborn. Pediat Clinic of North Am. 2009;56(3):579-600.
Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure Study Group. J Perinatol: Offi J Cal Perinat Assoc. 1995;15(6):470-9.
Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: a clinical and electroencephalographic study. Arch Neurol. 1976;33(10):696-705.
Levene ML, Kornberg J, Williams TH. The incidence and severity of post-asphyxial encephalopathy in full-term infants. Early Human Develop. 1985;11(1):21-6.
Pratesi S, Dani C. Meconium aspiration syndrome. In: Buonocore G, Bracci R, Weindling M, Buonocore G(ed.) Neonatology - A Practical Approach to Neonatal Diseases. Italy: Springer Science and Business Media; 2012. p. 425-7.
Swain P, Thapalial A. Meconium stained amniotic fluid–a potential predictor of meconium aspiration syndrome. J Nepal Paediat Soc. 2008;28(1):3-6.
Sori DA, Belete A, Wolde M. Meconium Stained Amniotic Fluid: Factors affecting Maternal and Perinatal Outcomes at Jimma University Specialized Teaching Hospital, South West Ethiopia. Gynecol Obstet (Sunnyvale). 2016;6(394):2161-0932.
Hanoudi M, Basil Mohammed Murad A, Duraid Ali A. Meconium Staining of Amniotic Fluid: A Clinical Study. Br J Med Med Res. 2014;4(43):914-21.
Bezboruah G, Chakraborty A, Bhunia N. A Study of Clinico-Epidemiological Profile of Meconium Aspiration Syndrome in Newborn Admitted in NICU of Gauhati Medical College and Amp; Hospital. Sch J Appl Med Sci Sch J App Med Sci. 2016;4(10A):3553-6.
Coltart TM, Byrne DL, Bates SA. Meconium aspiration syndrome: a 6‐year retrospective study. BJOG: Int J Obstet Gynaecol. 1989;96(4):411-4.
Joseph K, UdayKiran G, Reddy DR, Jain CS. Incidence of Meconium Aspiration Syndrome and Associated Risk Factors in Babies Born to Mothers with Meconium Stained Amniotic Fluid. Int J Contemp Med Res. 2017;4(7):1457-61.
Rajput U, Jain A. Impact of meconium stained amniotic fluid on early neonatal outcome. Journal of Evolution of Medical and Dental Sciences. 2013;2(45):8788-94.
Vora H, Nair S. Study of Meconium Aspiration Syndrome in Neonates. GCSMC J Med Sci. 2014;3(1):64-6.
Naveen S, Kumar SV, Ritu S, Kushia P. Predictors of meconium stained amniotic fluid: a possible strategy to reduce neonatal morbidity and mortality. J Obstet Gynecol India. 2006;56(6):514-7.
Louis D, Sundaram V, Mukhopadhyay K, Dutta S, Kumar P; Predictors of mortality in neonates with meconium aspiration syndrome. Indian Pedia. 2014;51(8):637-40.
Chandran JR, Uma DN, Rajeshwary U. Risk factors for Meconium aspiration and MAS (Meconium aspiration syndrome) in neonates born through meconium stained amniotic fluid (MSAF) in a tertiary care centre in Malabar (Kerala). Journal of Evol Med Dental Sci. 2013;2(49):9489-95.
Yong YP, Ho LY. A 3-year review of meconium aspiration syndrome. Singapore Med J. 1997;38(5):205-8.
Ashtekar SD, Renuka S, Gaikwad NK. Clinical study of meconium asp relation to birth weight and gest general hospital Sangli. Int Med J. 2014;1(5).
Yamada T, Matsubara S, Minakami H, Kohmura Y, Hiratsuka M, Sato I. Chemotactic Activity for Polymorphonuclear Leukocytes: Meconium Versus Meconium Stained Amniotic Fluid. Am J Reproduct Immunol. 2000;44(5):275-8
Xu H, Hofmeyr J, Roy C, Fraser WD. Intrapartum amnioinfusion for meconium stained amniotic fluid: a systematic review of randomised controlled trials. BJOG: Int J Obstet Gynaecol. 2007;114(4):383-90.