Meconium aspiration syndrome and neonatal outcome: a hospital based study
DOI:
https://doi.org/10.18203/2349-3291.ijcp20192038Keywords:
Meconium aspiration syndrome, Neonates, MSAF, OutcomeAbstract
Background: The incidence of meconium stained amniotic fluid is 8-20% among all deliveries. The Aspiration of meconium into the airway results in various short term and long term morbidities and mortality. Timely management of these neonates with meconium in amniotic fluid may prevent Meconium aspiration syndrome.
Methods: This prospective cohort study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. All live Term neonates born between December 2016 and July 2018 with meconium in amniotic fluid were enrolled in the study. Details of the neonate was entered in the pre-designed Proforma. The objective of this study the outcome of MAS neonates and find factors associated with Meconium aspiration syndrome when compared with Meconium stained amniotic fluid neonates as a whole. These associated factors were presented as Odds Ratio (OR) and 95% Confidence Interval. Chi-square test was done where applicable and a p-value <0.05 was taken as significant.
Results: Meconium aspiration syndrome was seen in 79 out of the 188 neonates born with meconium stained amniotic fluid.
Conclusions: The morbidity and mortality in a neonate with Meconium stained amniotic fluid (MSAF) to develop meconium aspiration syndrome (MAS) can be avoided with timely antenatal care. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which may lead to the mortality. Those neonates with risk for adverse outcome should be managed with special focus on respiratory care with use of assisted ventilation and inhaled nitric oxide and extracorporeal membrane oxygenation, where available.References
Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatr. 1990;85:715-21.
Woods JR, Glantz JC. Significance of amniotic fluid meconium. In: Creasy RK, Resnik R, editors. Maternal-Fetal Medicine: Principles and Practice. Philadelphia: WB Saunders, 1994:413-422.
Krebs HB, Peters RE, Dunn LJ. Intrapartum fetal heart rate monitoring III. Association of meconium with abnormal fetal heart rate patterns. Am J Obstet Gynecol. 1980;137:936-943.
Mazor M, Hershkovitz R, Bashiri A, Maymon E, Schreiber R, Dukler D, et al. Meconium stained amniotic fluid in preterm delivery is an independent risk factor for perinatal complications. Eur J Obstet Gynecol Reprod Biol. 1998;81:9-13.
Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome: unresolved issues. Pediatr Clin N Am. 1993;50:955-81.
Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome: an update. Pediatr Clin N Am. 1998;45:511-29.
Fleischer A, Anyaegbunam A, Guidetti D, Randolph G, Merkatz IR. A persistent clinical problem: profile of the term infant with significant respiratory complications. Obstet Gynecol. 1992;79:185-90.
Nathan L, Leveno KJ, Carmody TJ, Kelly MA, Sherman ML. Meconium: a 1990s perspective on an old obstetric hazard. Obstet Gynecol 1994;83:329-32.
Reed CB. Fetal death during labor. Surg Gynecol Obstet 1918;26:545-51.
Brews A. Fetal asphyxia. In Eden Hollands Manual of Obstetrics, 9th ed. London: Churchill, 1948:609-12.
Walker J. Foetal anoxia. J Obstet Gynecol Br Empire. 1954;61:162-80.
Steer PJ, Eigbe F, Lissauer TJ, Beard RW. Interrelationships among abnormal cardiotocograms in labor, meconium staining of the amniotic fluid, arterial cord blood pH, and Apgar scores. Obstet Gynecol. 1989;74:715-21.
Firdaus U, Ali SM, Sachdeva S. Maternal and neonatal factors associated with meconium stained amniotic fluid. Current Pediatr Res. 2013;17(1):37-40.
Hanoudi BM, Murad AM, Ali AD. Meconium staining of amniotic fluid: A clinical study. J Adv Medicine Med Res. 2014:914-21.
Rajput U, Jain A. Impact of Meconium Stained Amniotic Fluid on Early Neonatal Outcome. J Evolution Med Dental Sci. 2013;2(45):8788-94.
Bhatia, P, Ela N. Fetal and neonatal outcome of babies in meconium stained amniotic fluid and meconium aspiration syndrome. J Obste tGynecol India. 2007;57(6):501-4.
Lee K, Mi LS, Jin YH, Park C, Mazaki-Tovi S, Hyun YB, et al. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med. 2011;24(7):880-5.
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). J Evolution Med Dental Sci. 2013;2 (49):9489-95.
Vivian-Taylor J, Sheng J, Hadfield R, Morris J, Bowen J, Roberts C. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. Int J Obstetr Gynaecol. 2011;18(13): 1601-7.
Hiremath PB, Bahubali G, Meenal C, Bansal N, Ragaramya. The Management Practices and Outcome of Meconium Stained Amniotic Fluid. Int J Biol Med Res. 2012;3(3): 2204-7.
Ramakishore AV, Subramanyam KL, Mahesh G. A study on meconium aspiration syndrome cases attending to Government general hospital, Anantapuramu, Andhra Pradesh. Int J Res Health Sci. 2015;3(1):169-73.
Naqvi SB, Manzoor S. Association of meconium stained amniotic fluid with perinatal outcome in pregnant women of 37-42 weeks gestation. Pak J Surg. 2011;27(4): 292-8.
Khatun MH, Arzu J, Haque E, Kamal MA, Al Mamun MA, Khan MF, Hoque MM. Fetal outcome in deliveries with meconium stained liquor. Bangladesh J Child Health. 2009;33(2):41-5.
Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr. 2011 Nov 30;2012.
Espinheira M, Grilo M, Rocha G, Guedes B, Guimarães H. Meconium aspiration syndrome - the experience of a tertiary center. Portuguese J Pulmonol. 2011;17(2):71-6.
Louis D, Sundaram V, Mukhopadhyay K, Dutta S, Kumar P. Predictors of mortality in neonates with meconium aspiration syndrome. Indian Pediatr. 2014;51(8):637-40.
Hofer N, Jank K, Resch E, Urlesberger B, Reiterer F, Resch B. Meconium aspiration syndrome–a 21-years’ experience from a tertiary care center and analysis of risk factors for predicting disease severity. Clin Pediatr. 2013;225(07):383-8.
Yeh TF. Core Concepts: Meconium Aspiration Syndrome: Pathogenesis and Current Management. Neo Reviews. 2010;11(9):e503-12.
Goldsmith JP. Continuous positive airway pressure and conventional mechanical ventilation in the treatment of meconium aspiration syndrome. J Perinatol. 2008;28(S3):S49.
Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K, et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Obstetr Gynecol Survey. 2000;55(7):419-21.
Dargaville PA. Respiratory support in meconium aspiration syndrome: a practical guide. Int J Pediatr. 2012;2012.
Velaphi S, Van Kwawegen A. Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources. J Perinatol. 2008;28(S3):S36.