Meconium Aspiration Syndrome and Neonatal Outcome: A Prospective Study

Eva Gauchan^1, , Sahisnuta Basnet¹ and Tejesh Malla¹

¹Department of Pediatrics, Manipal Teaching Hospital, Pokhara, Nepal

Cite this paper

Eva Gauchan, Sahisnuta Basnet and Tejesh Malla. Meconium Aspiration Syndrome and Neonatal Outcome: A Prospective Study. American Journal of Public Health Research. 2015; 3(5A):48-52. doi: 10.12691/AJPHR-3-5A-11

Abstract

Meconium staining of amniotic fluid occurs in 10-15% deliveries and meconium aspiration syndrome occurs in 5% of those deliveries. Aspiration of meconium into the trachea results in various short and long term morbidities and variable mortality. These can be prevented by timely interventions before and after delivery. Aim of this study was to identify the neonatal factors associated with meconium aspiration syndrome and factors associated with mortality in these babies. The study included all babies admitted for meconium staining of amniotic fluid during the period of August 2013 till December 2014. Meconium aspiration syndrome was diagnosed if respiratory distress occurred immediately to within 24 hours after birth in a meconium stained baby, with radiological evidence of aspiration into the lungs and need for supplemental oxygen, after exclusion of other causes of respiratory distress. Data was analyzed by SPSS version 19 and presented as actual numbers and percentages. 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. Meconium aspiration syndrome was diagnosed in 50 out of 78 admitted newborns. Factors associated with meconium aspiration syndrome were respiratory distress starting immediately after birth, admission Downe score >4 and abnormal chest x-ray findings. Factors associated with mortality were small for gestational age newborns, 5 minute APGAR score <7, severe hypoxic ischemic encephalopathy, requirement for bag-mask ventilation and chest compression at birth and need for assisted ventilation. Neonatal morbidity and mortality in meconium aspiration syndrome is preventable by proper antenatal care and timely intervention after birth. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which contribute to the mortality. Those babies having 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.

Keywords

meconium aspiration syndrome, neonates, Nepal

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference?. Pediatrics. 1990; 85(5): 715-721.
[2]	Yeh TF. Core Concepts: Meconium Aspiration Syndrome: Pathogenesis And Current Management. NeoReviews. 2010. 11(9). e503-e512.
[3]	Goldsmith JP. Continuous Positive Airway Pressure And Conventional Mechanical Ventilation In The Treatment Of Meconium Aspiration Syndrome. J Perinatol. 2008.28. S49-S55.
[4]	Sarnat HB, Sarnat MS. Neonatal Encephalopathy Following Fetal Distress: A Clinical and Electroencephalographic Study. Arch Neurol. 1976;33(10): 696-705.
[5]	Sathian B, Sreedharan J, Baboo NS, Sharan K, Abhilash ES, Rajesh E. Relevance of Sample Size Determination in Medical Research. Nepal J Epidemiol. 2010;1: 4-10.
[6]	MacFarlane PI. Heaf DP. Pulmonary Function In Children After Neonatal Meconium Aspiration Syndrome. Arch Dis Child. 1988;63:368-372.
[7]	Khan AM, Elidemir O, Epstein CE, Lally KP, Xue H, Blackburn M., et al. Meconium Aspiration Produces Airway Hyperresponsiveness And Eosinophilic Inflammation In A Murine Model. Am J Physiol Lung Cell Mol Physiol. 2002;283(4). L785-L790.
[8]	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 Evolution of Medical and Dental Sciences. 2013;2 (49):9489-9495.
[9]	Zoe I, Charalampos G, Charalampos S, Georgios C, Michail V, Nikolaos V. Association of Meconium Stained Amniotic Fluid with Fetal and Neonatal Brain Injury, INTECH Open Access Publisher, 2012.
[10]	Swain P, Thapalial A. Meconium Stained Amniotic Fluid – A Potential Predictor Of Meconium Aspiration Syndrome. Journal of Nepal Paediatric Society. 2008; 28(1); 3-6.
[11]	Hanoudi BM, Murad AM, Ali AD. Meconium Staining of Amniotic Fluid: A Clinical Study. Br J Med Med Res. 2014; 4(3):914-921.
[12]	Firdaus U, Ali SM, Sachdeva S. Maternal and neonatal factors associated with meconium stained amniotic fluid. Current Pediatr Res. 2013;17 (1):37-40.
[13]	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):8788-8794.
[14]	Bhatia, P, Ela N. Fetal and neonatal outcome of babies in meconium stained amniotic fluid and meconium aspiration syndrome. J Obstet Gynecol India. 2007;57 (6):501-504.
[15]	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):880-885.
[16]	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. BJOG: An International Journal of Obstetrics & Gynaecology. 2011;18(13): 1601-1607.
[17]	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): 2204-2207.
[18]	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 [Internet]. 2015; 3(1): 169-173.
[19]	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): 292-298.
[20]	Khatun, H.A., Arzu, J., Haque, E., Kamal, M.A., Al Mamun, M.A., Khan, M.F.H., et al, “Fetal outcome in deliveries with meconium stained liquor,” Bangladesh J Child Health. 2009;33(2): 41-45.
[21]	Fischer, C., Rybakowski, C., Ferdynus, C., Sagot, P., Gouyon, J.B., “A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation,” International Journal of Pediatrics. 2012;1-7.
[22]	Khazardoost, S., Hantoushzadeh, S., Khooshideh, M., Borna, S., “Risk factors for meconium aspiration in meconium stained amniotic fluid,” J Obstet Gynaecol. 2007;27(6): 577-579.
[23]	Kumari, S., Gupta, S.N., Mahato, I.P., Giri, R., Yadav, A., Thakur, A., et al, “Maternal and fetal outcome in term labour with meconium stained amniotic fluid,” Health Renaissance. 2012; 10(3): 198-202.
[24]	Espinheira, M., Grilo, M., Rocha, G., Guedes, B., Guimarães, H., “Meconium aspiration syndrome - the experience of a tertiary center,” Revista Portuguesa de Pneumologia (English Edition). 2011;17(2):71-76.
[25]	Louis, D., Sundaram, V., Mukhopadhyay, K., Dutta, S., Kumar, P., “Predictors of mortality in neonates with meconium aspiration syndrome,” Indian Pediatrics. 2014: 51: 637-640.
[26]	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,” Klin Padiatr, 2013;225(07); 383-388.
[27]	Wiswell, T., Gannon, C., 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,” Pediatrics. 2000;105(1):1-7.
[28]	Dargaville, P., “Respiratory Support in Meconium Aspiration Syndrome: A Practical Guide,” International Journal of Pediatrics. 2012: 1-9.
[29]	Velaphi, S.,Van Kwawegen, A., “Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources,” Journal of Perinatology. 2008; 28:S36-S42.
[30]	Lin, H., Wu, S., Wu, J., Yeh, T., “Meconium aspiration syndrome: experiences in Taiwan,” Journal of Perinatology, 2008;28: S43-S48.
[31]	Anwar, Z., Butt, T.K., Anjum, F., Kazi, M.Y., “Mortality in meconium aspiration syndrome in hospitalized babies,” Journal of the College of Physicians and Surgeons Pakista. 2011;21(11): 695-699.
[32]	Dargaville, P., Copnell, B., “The Epidemiology of Meconium Aspiration Syndrome: Incidence, Risk Factors, Therapies and Outcome,” Pediatrics. 2006; 117(5): 1712-1721.