Risk factors, clinical characteristics and outcome in neonates with meconium aspiration syndrome - an experience at tertiary care hospital

Mohmad S. Chesti, Naveed Shahzad, Shivani Goswami, Sheenam Gazala


Background: Meconium aspiration syndrome (MAS) is a life-threatening condition involving respiratory system, the present study was undertaken to study maternal risk factors associated with MAS, etiology, incidence of MAS born via meconium-stained amniotic fluid (MSAF) and to assess outcome of neonates born with MAS.


Methods: The present study was carried out at Government Medical College, Baramulla from August 2017 to August 2019, all neonates fulfilling inclusion criteria got admitted in neonatal intensive care unit (NICU) and were included in our study after obtaining informed consent from their parents. The demographic and factors related to MAS were recorded through predesigned proforma and analyzed using Microsoft excel. Mean and standard deviation were determined for quantitative variables whereas frequency and percentages were calculated for qualitative variables.


Results: Newborn with MAS were mostly depressed at birth and hypoxic ischemic encephalopathy (HIE stage III) was main cause of neonatal mortality, significantly contributing 37.5% of cases of MAS. Neonatal mortality in MAS was also associated with 5 minute low APGAR score. 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.


Conclusions: We conclude from our study that MAS is most commonly seen in term and post term babies with birth weight >2.5 kg. Risk factors should be identified and timely intervention should be done to reduce, mortality and morbidity in MAS.



Meconium aspiration syndrome, Risk factors, APGAR score, Neonates outcome

Full Text:



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

Sadaf R, Mehrunnisa K, Khanum F, Zahid M, Khan S. Fetal outcome in deliveries of patients with meconium stained liquor. J Med Sci. 2012;20:165-7.

Kliegman R, Bonita S, St Geme J, Stoll N. Nelson Textbook of Pediatrics. In: Nelson Textbook of Pediatrics. 1st ed. Philadelphia: Elseivier Saunders. 2015;859-62.

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;158(2):259-64.

Avery GB, Fletcher MA, MacDonald MG. Neonatology, pathophysiology and management of newborn, 9th edition. Philadelphia: Lippincot. 2015;552.

Bhat RY, Rao A. Meconium-stained amniotic fluid and meconium aspiration syndrome: a prospective study. Ann Tropi Paediatr. 2008;28(3):199203.

Eichenwald E, Hansen A, Martin CS. Cloherty and Stark’s Manual of Neonatal Care. 8th edition. Philadelphia: Wolters Kluwer. 2017;404-34.

Narang A, Nair PMC, Bhakoo ON, Vashist K. Management of meconium stained amniotic fluid- A team approach. Indian Pediatr. 1993;30:9-13.

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

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):2161-932.

Rajput U, Jain A. Impact of meconium stained amniotic fluid on early neonatal outcome. J Evol Med Dent Sci. 2013;2(45):8788-94.

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

Naqvi SB, Manzor S. association of MSAF with perinatal outcome in pregnant women of 37-42 weeks gestation. Pak J Surg. 2011;27(4):292-8.

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;121(1):45-50.

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).

Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB, et al. A Population-Based Study of Meconium Aspiration Syndrome in Neonates Born between 37 and 43 Weeks of Gestation, Int J Pediatr. 2012;321545.

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: intra partum and neonatal attributes. AMJ Obstet Gynecol. 1989;161:1106-10.

Naranga A. Management of mecosaf: a team approach. Indian Pediatr. 1993;30:9-13.

Viraraghavan VR, Nangia S, Prathik BH, Madarkar BS, Deepshika R, Saili A. Yield of meconium in non-vigorous neonates undergoing endotracheal suctioning and profile of all neonates born through meconium-stained amniotic fluid: A prospective observational study. Paediatr Int Child Health. 2018;00:1-5.

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.