DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20194185

A study on clinical profile of meconium aspiration syndrome in relation to gestational age and birth weight and their immediate outcome

Manivannan V., Jegan Murugan R., Devandiran R. S.

Abstract


Background: Aim of the study was to understand the factors causing meconium aspiration syndrome (MAS) in relation to gestational age and birth weight and their immediate outcome.

Methods: This study was done on babies admitted in the neonatal intensive care unit (NICU) of Thanjavur medical college hospital, who fulfilled the criteria of MAS. Babies born with meconium stained amniotic fluid (MSAF), were resuscitated as per NRP guidelines. The babies with complications of MAS were admitted to NICU and were observed for their immediate outcome in the hospital.

Results: MAS occurred most commonly in babies having fetal distress and in mothers with history of PIH. It is seen more commonly in babies born through caesarean section and in term babies with mean gestational age of 38-40 weeks of gestation and mean birth weight of 2.71 kg. Most babies were depressed at birth and most common cause of mortality was hypoxic ischemic encephalopathy (HIE stage III), significantly contributing 37.5% of cases of MAS. There was significant and strong association between the birth weight and mortality. Thick MSAF was significantly associated with need for mechanical ventilation and subsequently higher mortality. Babies born through caesarean section with MAS also had significantly poor outcome.

Conclusions: MAS is an entity which is commonly seen in term and post term babies with birth weight >2.5 kg. There is a significant correlation between the birth weight and outcome in MAS. When thick meconium stained liquor is noted prior to birth, anticipation is necessary and non vigorous babies need aggressive management and possibly early ventilation. Asphyxiated babies should be followed up astutely. Continuous monitoring and early intervention, followed by due resuscitation as per guidelines can reduce the morbidity, complications and the mortality in MAS.


Keywords


Birth weight, Gestational age, Immediate outcome, Meconium aspiration syndrome

Full Text:

PDF

References


Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome: unresolved issues. Pediatric Clinics of North America. 1993 Oct 1;40(5):955-81.

Trimmer KJ, Gilstrap LC, Meconiumcrit and birth asphyxia. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 1):1010-3.

Goud P, Krishna U. Significance of meconium staining of amniotic fluid in labour. J Obstet Gynaecol India. 1989;39:523-6.

Usher RH, Boyd ME, McLean FH, Kramer MS. Assessment of fetal risk in postdate pregnancies. Am J Obstet Gynecol. 1988 Dec 1;158(2):259-64.

Sherry SN, Kramer I. The time of passage of the first stool and first urine by the newborn infant. J Pediatr. 1955 Feb 1;46(2):158-9.

Bhat RY, Rao A. Meconium-stained amniotic fluid and meconium aspiration syndrome: a prospective study. Annals Tropi Paediatr. 2008 Sep 1;28(3):199-203.

Narang A, Nair PM, Bhakoo ON, Vashisht K. Management of meconium stained amniotic fluid: A team approach. Ind Pediatr. 1993 Jan;30:9-13.

Bhusan K, Mircahndani JJ. Correlation of bubble stability test with birth weight and dubowitz score for maturity. J Obstet Gyn India. 1978;28:747.

Rao B, Chandrashekhar GS, Rao D, Hegde P, Ghate SV. Meconium stained amniotic fluid-A prospective study. Karnataka Pediat J. 2011;25(1):21-2.

Coughtrey H, Jeffery HE, Hendersonā€Smart DJ, Storey B, Poulos V. Possible causes linking asphyxia, thick meconium and respiratory distress. Austr New Zealand J Obstet Gynaecol. 1991 May;31(2):97-102.

Yeh SY, Paul RH, Schifrin BS, Martin CB, Hon EH. Significance of meconium during labour. Am J Obestet Gynecol. 1975;122:573-80.

Fujikura T, Klionsky B. The significance of meconium staining. Am J Obstet Gynecol. 1975 Jan 1;121(1):45-50.

Gupta V, Bhatia BD, Mishra OP. Meconium stained amniotic fluid: antenatal, intrapartum and neonatal attributes. Ind Pediatr. 1996;33:293-7.

Hofmeyr GJ, Xu H, Eke AC. Amnioinfusion for meconiumā€stained liquor in labour. Cochrane Database of Systematic Reviews. 2014(1).

Alchalabi, At Abu-Heija, E El-Sunna, F Zayed, Lf Badria, A Obeidat2 H. Meconium-stained amniotic fluid in term pregnancies-a clinical view. J Obstet Gynaecol. 1999 Jan 1;19(3):262-4.

Eiden RD, Seifert LS, Winegar A. Perinatal characteristics of uncomplicated postdate pregnancies. Obstet Gynecol. 1987;151:731.

Suresh GK, Sarkar S. Delivery room management of infants born through thin meconium stained liquor. Ind Pediatr. 1994;31:1177-8.

Wiswell TE, Cleary GM. Meconium stained amniotic fluid and meconium aspiration syndrome. An update. Pediatr Clin North Am. 1998;45:511-29.

Rossi EM, Philipson EH, Williams TG, Kalhan SC. Meconium aspiration syndrome. intrapartum and neonatal attributes. Am Am J Obstet Gynecol. 1989;161(5):1106-10.

Davis RO, Philips JB III, Harris BA Jr, Wilson ER, Huddleston JF. Fetal meconium aspiration syndrome occurring despite airway management considered appropriate. Am Am J Obstet Gynecol. 1985;151:731-6.

Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium stained neonates before delivery of their shoulders; multicentre, RCT. Lancet. 2004;364:597-602.