Meconium Staining and Its Effect on Hospital Care During the Neonatal Period

Abstract

Objective: to characterize differences in outcome and course of newborn care between births with meconium-stained amniotic fluid and those with clear amniotic fluid.Design: prospective cohort study complemented by retrospective chart review.Setting: London Health Sciences Centre.Participants: all live singleton births delivered at LHSC between January 1 and December 31, 1996. Excluded were multiple births and elective Caesarean sections.Outcome Measures: degree of resuscitation performed on newborns, Apgar scores, paediatric consultations, transfers from newborn nursery to higher level of care, hospital revisit and readmission rates within 30 days of discharge.Results: there were a total of 126 births associated with thick meconium staining, 194 with thin meconium staining, and 52 with terminal meconium only. Resuscitation efforts were undertaken in 54.0 percent of thick meconium births, 32.5 percent of thin meconium births, 30.8 percent of terminal meconium births and 17.3 percent of births with clear amniotic fluid, a significant difference (p<0.001). One-minute Apgar scores less than 7 occurred in 23.0 percent of thick meconium births, 14.4 percent of thin meconium births 7.7 percent of terminal meconium births and 6.4 percent of births with clear amniotic fluid. Five-minute Apgar scores less than 8 were significantly more common (5.5%) in meconium-stained births of all types (thick, thin, and terminal) than in births with clear amniotic fluid (0.64%; p<0.001). Five percent of infants with meconium staining and 1.6 Percent of infants with clear amniotic fluid required paediatric critical care unit (PCCU) admission: a significant difference (p=0.016). Paediatric consultation rate after transfer from the delivery room was 18.3 percent for infants born with thick meconium, significantly more than the 10.0 percent for infants not born with thick meconium (p=0.014). There was no significant difference in frequency of subsequent visits to the emergency department or readmission rates in the first month after birth by infants who had any degree of meconium staining compared to those who had clear amniotic fluid.Conclusions: presence and degree of meconium-stained amniotic fluid prior to birth predicts an increased likelihood of resuscitative interventions and a possibility of increased intensity of care needed in the first few days of life.