Influence of foetal inflammation on the development of meconium aspiration syndrome in term neonates with meconium-stained amniotic fluid

Kyoko Yokoi,Satoru Kobayashi,Osuke Iwata,Kanji Muramatsu,Haruo Goto

doi:10.7717/peerj.7049

Kyoko Yokoi, Satoru Kobayashi + Show 3 more

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https://doi.org/10.7717/peerj.7049

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Journal: PeerJ	Publication Date: May 31, 2019
Citations: 8	License type: CC BY 4.0

Affiliation: Nagoya Medical Center, Nagoya City University

Abstract

BackgroundMeconium-stained amniotic fluid is observed in approximately 10–15% of all deliveries; however, only 5% of neonates with meconium-stained amniotic fluid develop meconium aspiration syndrome (MAS). Although foetal distress and subsequent sympathetic stimulation have been considered as the primary upstream events of MAS, this clinical complication sometimes occurs due to other pathologies, such as intraamniotic inflammation. The aim of this study was to investigate whether the incidence of MAS is associated with the presence of funisitis and chorioamnionitis in term neonates with meconium-stained amniotic fluid.MethodsBetween April 2013 and March 2015, a total of 95 term neonates with meconium-stained amniotic fluid, who were hospitalized at a neonatal intensive care unit, were enrolled in the study. The placenta and umbilical cord were histopathologically examined. Clinical variables and histopathological findings associated with the incidence of MAS were studied.ResultsA total of 36 neonates developed MAS. Univariate logistic regression analysis revealed that a heavier birth weight, male sex, 1-min Apgar score ≤ 7, funisitis (but not chorioamnionitis), and elevated acute-phase inflammatory reaction score were associated with increased incidence of MAS (all p < 0.05). The multivariate model comprised funisitis (OR = 5.03, 95% CI [1.63–15.5], 1-min Apgar score ≤ 7 (OR = 2.74, 95% CI [1.06–7.09], and male sex (OR = 3.4, 95% CI [1.24–9.34].ConclusionIn neonates with meconium-stained amniotic fluid, funisitis, as well as low 1-min Apgar score and male sex, was identified as an independent variable for MAS development. Intraamniotic inflammation might be involved in the pathological mechanisms of MAS.

Highlights

Meconium-stained amniotic fluid is observed in approximately 10–15% of all deliveries (Yoder et al, 2002), which has been considered as the primary cause of meconium
In neonates with meconium-stained amniotic fluid, funisitis, as well as low 1-min Apgar scores and male sex, was associated with increased incidence of MAS, pointing toward the role of inflammatory factors in the pathophysiology of MAS
Our study found that only the 1-min Apgar scores, but not the 5-min Apgar scores, and cord blood pH, were associated with MAS development, suggesting that antenatal hypoxic-ischemia is not sufficient to explain MAS development, and other control variables of MAS might exist

Summary

Introduction

Meconium-stained amniotic fluid is observed in approximately 10–15% of all deliveries (Yoder et al, 2002), which has been considered as the primary cause of meconiumHow to cite this article Yokoi K, Iwata O, Kobayashi S, Muramatsu K, Goto H. 2019. The use of surfactant replacement, nitric oxide therapy and extracorporeal membrane oxygenation has led to a marked decrease in mortality and morbidity associated with MAS in the recent times (Swarnam, Soraisham & Sivanandan, 2012) These therapeutic options are usually unavailable for neonates born in a low-resource setting. The aim of this study was to investigate whether the incidence of MAS is associated with the presence of funisitis and chorioamnionitis in term neonates with meconium-stained amniotic fluid. Conclusion: In neonates with meconium-stained amniotic fluid, funisitis, as well as low 1-min Apgar score and male sex, was identified as an independent variable for MAS development. Intraamniotic inflammation might be involved in the pathological mechanisms of MAS

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