Diagnosis Of Meconium Aspiration Syndrome Research Articles

Early Outcome of Neonates Admitted with Meconium Aspiration Syndrome.

Meconium aspiration syndrome is one of the commonest cause of respiratory distress in neonates. The incidence is still high in developing world. This study aims to study the clinical characteristics and early outcome of neonates admitted for meconium aspiration syndrome. This was a cross-sectional descriptive study done among neonates admitted to the neonatal Intensive Care Unit with a diagnosis of Meconium Aspiration syndrome. Relevant epidemiological, clinical and laboratory data were obtained. The early outcome of those neonate was studied. Out of 140 neonates with a mean birth weight of 2865 + 543 grams,73.6% were male, of which 76.4% were referred cases while 23.6% were inborn. Of them 69.3% had history of thin type of meconium while 30.7% had thick type of meconium during delivery. Of all mothers, 74.3% were primigravida, 4.3% had intrapartum fever of unknown source,11.4% suffered from urinary tract infection while 2.8% had hypertension. Premature rupture of membrane had occurred among 7.9% and oligohydramnios was found in 10%. Half of them (50.7%) had spontaneous vaginal delivery, 44.3% had caesarian section, while 4.8% had assisted delivery. Around one third of the neonates (37.1%) were given supplemental oxygen via nasal prongs, 25.7% via head box, 27.1% via continuous positive airway pressure and 10% intubated. Around half of the neonates (42.1%) had no complications. Complication noted were sepsis, birth asphyxia, seizures and polycythemia in 35%, 14.3%, 5.7% and 2.9% respectively. Mortality occurred among 5.0% of them. Meconium aspiration syndrome is one of the commonest cause of respiratory distress in a neonate which is associated with common maternal risk factors especially in primigravida which included Urinary tract infection, hypertension and oligohydramnios.

Frequency of PPHN in Neonates Having Confirmed Diagnosis of Meconium Aspiration Syndrome

Background: Optimal oxygenation, avoidance of respiratory and metabolic acidosis, normal blood pressure, sedation & pulmonary vasodilator treatment are among the management techniques for persistent pulmonary1hypertension of the newborn. Aim: To find frequency of PPHN in neonates having confirmed diagnosis of meconium aspiration syndrome. Study Design: Descriptive cross sectional study. Methodology: Total 240 neonates who fulfilled inclusion criteria were enrolled from Pediatrics Medicine Ittifaq hospital Lahore after getting informed consent form parents or attendants. Basic information like gestational age, gender, birth weight, APGAR score at 7 minutes, mode of delivery were taken (on antenatal record). All cases with confirmed diagnosis of MAS were underwent 2D Echocardiography and PPHN were diagnosed as per operational definition. All diagnostic procedure was done by a single consultant cardiologists. SPSS 20.0 was utilized to analyze the data. For quantitative data, mean and standard deviation were provided, while frequencies and percentages were provided for qualitative factors. Post stratification Chi-square test was applied taking p-value ≤ 0.05 as significant. Results: The mean birth weight was 3211.02±412.10 grams with min & max birth weight as 2500 and 3882 g. The mean APGAR score was 7.95±1.41. There were 85(35.4%) cases who had PPHN while 155(64.6%) cases did not have positive diagnosis of PPHN. Conclusions: It was concluded that frequency of PPHN in neonates having confirmed diagnosis of meconium aspiration syndrome is very high. So early screening during antenatal visits and adopting preventive strategies can only minimize the risk of meconium aspiration syndrome thus preventing PPHN. Keywords: Persistent Pulmonary Hypertension, Meconium Aspiration Syndrome, Meconium Stained Amniotic Fluid

Meconium Aspiration Syndrome: Analysis of Case Report

Introduction: The first stool of a newborn child is meconium. Meconium is a sticky material composed of denuded intestinal epithelium cells, bile acid, amniotic fluid, swallowed lanugo hair, digestive enzymes, water and mucus. Post-term infants are more likely to have meconium-stained amniotic fluid (MSAF). Meconium aspiration syndrome, a leading cause of severe illness and death in newborns, occurs in about 5 per cent to 10 per cent of births. Case study: A newborn male baby was admitted to the Neonatal Care Unit with the chief complaints of Term, vacuum extraction and thick MSAF and Respiratory Distress skin colour was found to be dark green in the chest and dorsal limb of the body. Breath sound was found to be abnormal with grunting sounds on examination with a stethoscope. The patient’s Clinical symptoms include the appearance of skin colour, and breath sound and Chest radiography shows the diagnosis of Meconium Aspiration Syndrome (MAS). The patient was treated with O2 through nasal continuous positive airway pressure, fluid management was based on daily body weight and antibiotics like ampicillin and gentamicin was administered at the time of admission. The Patients caretaker was advised to Kangaroo mother care and direct breastfeeding. Conclusion: Over the years, medication and care for newborns with meconium aspiration have evolved and changed. Prophylactic antibiotic therapy in MAS does not change the prognosis of patients. In newborns with extreme and recurrent hypoxemia caused by MAS, extracorporeal membrane oxygenation (ECMO) has been utilised as a last-resort therapy. Nevertheless, there are still several techniques for preventing and treating meconium aspiration syndrome; therefore research should continue to diminish illness and death caused by Meconium aspiration syndrome.

Risk Factors Leading to Meconium Aspiration Syndrome in Meconium-Stained Amniotic Fluid

OBJECTIVES This study aimed to find out the risk factors leading to meconium aspiration syndrome in patients having meconium-stained amniotic fluid. METHODOLOGY This comparative study was conducted in the department of Obstetrics and Gynaecology at Hayatabad Medical Complex from January 2022- June 2022. All patients admitted to the labour ward with the diagnosis of meconium-stained liquor (MSL) were included in the study through a convenient sampling technique. Patients were divided into two groups, group 1 having only meconium-stained amniotic fluid (MSAF) without meconium aspiration syndrome while group 2 having babies with the diagnosis of meconium aspiration syndrome (MAS). Both groups were compared for different risk factors for the development of MAS. Differences in the risk factors between the two groups were analyzed using Pearson’s correlation with a p-value of <0.05 considered significant. SPSS vs 20 was used for statistical analysis. RESULTS 84 patients were included in the study, i.e., 61 in group 1 and 23 in group 2. The mean age of the patients was 25± 3.45. The frequency of meconium-stained amniotic fluid was 3.83%. Meconium aspiration syndrome developed in 23 babies out of 84 MSAF deliveries (27.38%). Low APGAR score (< 0.00), patients handled outside the hospital (<0.001) and prolonged second stage (0.003) were significant risk factors for the development of MAS. CONCLUSION In the prolonged second stage, patients handled outside the hospital by unauthorized personnel and low APGAR score at birth were statistically significant risk factors for developing meconium aspiration syndrome.

Prediction score for prolonged hospital stay in meconium aspiration syndrome: A multicentric collaborative cohort of south India.

With improved survival in neonates with meconium aspiration syndrome (MAS), the focus is currently on mitigating the morbidities. The objective of this study was to predict factors determining prolonged hospital stay in neonates with MAS. It was a retrospective cohort from five centers of south India between 2018 and 2020. Neonates ≥35 weeks of gestation admitted to neonatal intensive care unitwith the diagnosis of MAS and requiring oxygen beyond 24 h of life were included in the study. The morbidities in the neonates with stay ≤7 days (short stay) were compared with >7 days (prolonged stay). Logistic regression by the backward stepwise method was used for predictive score creation. Out of 347 neonates with MAS discharged home, 103 (29%) had a short stay and 244 (71%) had prolonged stay. The primary support beyond O2 (continuous positive airway pressure/mechanical ventilation) (42% vs. 83%, p < 0.001), fractional inspired oxygen (FiO2 ) at 1 h >30% (45% vs. 87%, p < 0.001), hypoxic ischemic encephalopathy(HIE) stage2 or 3 (1% vs. 27%, p < 0.001), moderate-severe persistent pulmonary artery hypertension(PPHN) (3% vs. 31%, p < 0.001) were independent factors associated with prolonged stay on logistic regression. A prediction model was devised using weighted scores of these four associated morbidities. The clinical score thus developed had 83% sensitivity, 68% specificity for the prediction of prolonged stay (area under curve:82%, 95% confidence interval [78-87], p < 0.001). More than two-thirds of neonates with MAS had prolonged stay. The primary support beyond oxygen, FiO2 requirement >30%, Moderate to severe PPHN, HIE stage2 or 3 were predictive of prolonged stay in neonates with MAS.

Machine Learning Algorithm-Based Analysis of Efficacy of Pulmonary Surfactant Combined with Mucosolvan in Meconium Aspiration Syndrome of Newborns through Ultrasonic Images

Objective. The study aimed to explore the efficacy of pulmonary surfactant (PS) combined with Mucosolvan in the diagnosis of meconium aspiration syndrome (MAS) in newborns through ultrasonic images of lung based on machine learning. Methods. 138 cases of infants with MAS were selected as the research subjects and randomly divided into PS group (n = 46), Mucosolvan group (n = 46), and combination group (n = 46). Then, ultrasonic images based on machine learning algorithm were used for examination. On the basis of conventional treatment, the PS group accepted intratracheal PS drip treatment with 100 mg/kg. For the Mucosolvan group, 7.5 mg/kg of Mucosolvan was added with 50 g/L glucose, which was diluted to 3 mL. Then, the mixture was injected intravenously with a micropump for more than 5 min. The combination group received combined treatment of PS and Mucosolvan. If there was no relief or the symptoms aggravated after 12 h of PS treatment, the patient should be treated again. 7.5 mg/kg/d of Mucosolvan was given for 7 days. Mechanical ventilation time, hospitalization time, oxygenation index (OI) before treatment, at 3 d and at 7 d after treatment, and arterial/alveolar oxygen ratio (a/APO2) of the three groups were detected and compared. Besides, in-hospital mortality and complication rate of the three groups were statistically compared. Results. Ultrasonic image edge detection based on machine learning algorithm was more condensed and better than Sobel operator. Compared with the PS group and the Mucosolvan group, treatment efficiency, OI at 3 d and at 7 d after treatment, and a/APO2 of combination group were increased. Mechanical ventilation time and hospitalization time of the combination group were shortened, and mortality rate of the combination group was reduced ( P &lt; 0.05). Compared with the situation before treatment, OI at 3 d and at 7 d after treatment and a/APO2 of the combination group were increased, and OI at 7 d after treatment and a/APO2 of the PS group and the Mucosolvan group were increased ( P &lt; 0.05). Curative effect, mechanical ventilation time, hospitalization time, OI before and after treatment, a/APO2, and mortality rate during hospitalization of the PS group and the Mucosolvan group had no significant difference ( P &gt; 0.05). There was no significant difference in the complications rates in the three groups ( P &gt; 0.05). Conclusion. Pulmonary ultrasound based on machine learning algorithm can be used in the diagnosis of MAS in neonates. PS combined with Mucosolvan is feasible and safe in treating neonatal MAS and effectively improves the pulmonary oxygenation function. Therefore, it is worthy of clinical application.

Association of Adherence to Surfactant Best Practice Uses With Clinical Outcomes Among Neonates in Sweden

While surfactant therapy for respiratory distress syndrome (RDS) in preterm infants has been evaluated in clinical trials, less is known about how surfactant is used outside such a framework. To evaluate registered use, off-label use, and omissions of surfactant treatment by gestational age (GA) and associations with outcomes, mainly among very preterm infants (GA <32 weeks). This population-based cohort study used registry data for 97 377 infants born in Sweden between 2009 and 2018. Infants did not have malformations and were admitted for neonatal care. Data analysis was conducted from June 2019 to June 2020. Timing and number of surfactant administrations, off-label use, and omission of use. Registered use was defined by drug label (1-3 administrations for RDS). Omissions were defined as surfactant not administered despite mechanical ventilation for RDS. In-hospital survival, pneumothorax, intraventricular hemorrhage grade 3 to 4, duration of mechanical ventilation, use of postnatal systemic corticosteroids for lung disease, treatment with supplemental oxygen at 28 days' postnatal age and at 36 weeks' postmenstrual age. Odds ratios (ORs) were calculated and adjusted for any prenatal corticosteroid treatment, cesarean delivery, GA, infant sex, Apgar score at 10 minutes, and birth weight z score of less than -2. In total, 7980 surfactant administrations were given to 5209 infants (2233 [42.9%] girls; 2976 [57.1%] boys): 629 (12.1%) born at full term, 691 (13.3%) at 32 to 36 weeks' GA, 1544 (29.6%) at 28 to 31 weeks' GA, and 2345 (45.0%) at less than 28 weeks' GA. Overall, 977 infants (18.8%) received off-label use. In 1364 of 3508 infants (38.9%) with GA of 22 to 31 weeks, the first administration of surfactant was given more than 2 hours after birth, and this was associated with higher odds of pneumothorax (adjusted OR [aOR], 2.59; 95% CI, 1.76-3.83), intraventricular hemorrhage grades 3 to 4 (aOR, 1.71; 95% CI, 1.23-2.39), receipt of postnatal corticosteroids (aOR, 1.57; 95% CI, 1.22-2.03), and longer duration of assisted ventilation (aOR, 1.34; 95% CI, 1.04-1.72) but also higher survival (aOR, 1.45; 95% CI, 1.10-1.91) than among infants treated within 2 hours of birth. In 146 infants (2.8%), the recommended maximum of 3 surfactant administrations was exceeded but without associated improvements in outcome. Omission of surfactant treatment occurred in 203 of 3551 infants (5.7%) who were receiving mechanical ventilation and was associated with lower survival (aOR, 0.49; 95% CI, 0.30-0.82). In full-term infants, 336 (53.4%) of those receiving surfactant had a diagnosis of meconium aspiration syndrome. Surfactant for meconium aspiration was not associated with improved neonatal outcomes. In this study, adherence to best practices and labels for surfactant use in newborn infants varied, with important clinical implications for neonatal outcomes.

NICU Admissions for Meconium Aspiration Syndrome before and after a National Resuscitation Program Suctioning Guideline Change.

The Textbook of Neonatal Resuscitation, seventh edition, does not suggest routine endotracheal suctioning for non-vigorous infants born through meconium-stained amniotic fluid. We compared 301,150 infants at ≥35 weeks’ gestational age inborn at 311 Vermont Oxford Network member centers in the United States (U.S.) and admitted to neonatal intensive care units (NICU) who were born before (2013 to 2015) and after (2017) the guideline change. Logistic regression models adjusting for clustering of infants within centers were used to calculate risk ratios. NICU admissions for infants with a diagnosis of meconium aspiration syndrome (MAS) decreased from 1.8% to 1.5% (risk ratio: 0.82; 95% confidence interval: 0.68, 0.97) and delivery room endotracheal suctioning in this group decreased from 57.0% to 28.9% (0.51; 0.41, 0.62). Treatment with conventional or high frequency ventilation, inhaled nitric oxide, or extracorporeal membrane oxygenation remained unchanged 42.3% vs. 40.3% (0.95; 0.80, 1.13) among infants with MAS and 9.1% vs. 8.2% (0.91; 0.87, 0.95) among infants without MAS. The use of surfactant among infants with MAS increased from 24.6% to 30% (1.22; 1.02, 1.48). Mortality (2.6 to 2.9%, 1.12; 0.74, 1.69) and moderate/severe hypoxic-ischemic encephalopathy (5.4 to 6.8%, 1.24; 0.91, 1.69) increased slightly in 2017. Subgroup analyses of infants with 1 min Apgar scores of ≤3 found similar results. While NICU admissions for MAS and tracheal suctioning decreased after the introduction of the new guideline with no subsequent increase in severe respiratory distress among infants with and without a MAS diagnosis, limitations in our study preclude inferring that the new guideline is safe or effective.

Procalcitonin as Predictor of Bacterial Infection in Meconium Aspiration Syndrome.

There is a lack of definite consensus on indications for initiating antibiotics in neonates with meconium aspiration syndrome (MAS), instigating researchers to search for a biomarker that can help differentiate MAS from MAS with bacterial infection. Our primary objective was to compare serum procalcitonin (PCT) levels in full-term vigorous neonates having MAS with or without bacterial infection. Seventy term vigorous neonates with diagnosis of MAS were enrolled. Blood samples were taken for sepsis screen, C-reactive protein (CRP), PCT, and blood culture at 6 ± 2 hours of respiratory distress. Neonates were categorized into group 1 (MAS without bacterial infection) and group 2 (MAS with bacterial infection) based on blood culture. The duration of our study was 18 months. Mean ± standard deviation PCT level was 2.52 ± 3.99 in group 1 and 2.71 ± 4.22 in group 2, which was comparable. At cutoff of 0.1 ng/mL, PCT had a sensitivity of 90% and specificity of 8% in detecting bacterial infection. Mean total leukocyte count, absolute neutrophil count, immature to total leucocyte ratio, microerythrocyte sedimentation rate, and CRP were comparable. Though PCT is an early and reliable marker of neonatal infection, the levels were increased in neonates with MAS irrespective of the presence of bacterial infection.

Antibiotics for neonates born through meconium-stained amniotic fluid.

Approximately 1 in 10 pregnancies is affected by meconium passage at delivery, which can result in meconium aspiration syndrome (MAS). MAS can cause respiratory complications and, very rarely, death. Antibiotics have been prescribed for neonates exposed to meconium in amniotic fluid, with the intention of preventing infection due to potential bacterial contaminants. We conducted this review to assess the efficacy and safety of antibiotics for:1. prevention of infection, morbidity, and mortality among infants born through meconium-stained amniotic fluid (MSAF) who are asymptomatic at birth; and2. prevention of infection, morbidity, and mortality among infants born through MSAF who have signs and symptoms compatible with meconium aspiration syndrome (MAS). We performed a literature search using the following databases: MEDLINE (1966 to July 2016); Embase (1980 to July 2016); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to July 2016); and the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 7) in the Cochrane Library. We also searched clinical trials databases, conference proceedings, and reference lists of retrieved articles. We included randomised and quasi-randomised controlled trials that compared antibiotics administered via any route versus placebo or no treatment for prevention of infection among neonates exposed to MSAF, or who developed MAS. We excluded cohort, case control, and any other non-randomised studies and applied no language restrictions. We included studies of term and preterm infants, and we included studies examining use of any antibacterial antibiotics. We included studies that reported on any outcomes of interest. We assessed the methodological quality of included trials by reviewing information provided in study reports and obtained by personal communication with study authors. We extracted data on relevant outcomes, estimated effect size, and reported values as risk ratios (RRs), risk differences (RDs), and mean differences (MDs), as appropriate. We conducted subgroup analyses for treatment of MAS and for prophylaxis (asymptomatic neonates exposed to meconium). Four randomised controlled studies including a total of 695 participants were eligible for inclusion. Three studies evaluated neonates with MAS, and one study assessed asymptomatic neonates exposed to meconium in amniotic fluid. These studies exhibited varying degrees of methodological rigour: Two studies were at low risk of bias, and two were at unclear risk. We graded evidence derived from these studies as low quality. We downgraded overall evidence owing to the large number of participants lost to follow-up in one trial, the small sample sizes of all trials, and unclear methodological details provided for two trials.The primary outcome was risk of early- and late-onset neonatal sepsis. Antibiotics did not decrease the risk of sepsis in neonates with a diagnosis of MAS (RR 1.54, 95% confidence interval (CI) 0.27 to 8.96; RD 0.00, 95% CI -0.02 to 0.03; 445 participants, three studies; I² = 0%) nor in asymptomatic neonates exposed to meconium in amniotic fluid (RR 0.76, 95% CI 0.25 to 2.34; RD -0.01, 95% CI -0.07 to 0.04; 250 participants, one study; I² = 0%). Results show no significant differences in mortality or duration of stay in hospital between groups given antibiotics and control groups of symptomatic and asymptomatic neonates. One study in asymptomatic neonates reported a significant reduction in duration of mechanical ventilation for the control group compared with the antibiotic group (MD 0.26, 95% CI 0.15 to 0.37; 250 participants, one study; I² = 0%). Upon review of available evidence, we found no differences in infection rates following antibiotic treatment among neonates born through meconium-stained fluid and those with meconium aspiration syndrome. The overall quality of evidence is low owing to the small number of included studies. Well-controlled studies of adequate power are needed.

Lung ultrasonography for the diagnosis of meconium aspiration syndrome of the newborn infants

Objective To investigate the diagnostic value of lung ultrasonography for meconium aspiration syndrome (MAS). Methods From August 2014 to October 2015, a total of 67 cases of MAS patients were included in this study based on the medical history, typical clinical symptoms and chest X ray findings.The control group comprised 100 neonates without pulmonary disease.In a resting state, each patient was placed in a supine, lateral recumbent, or prone position.Using the anterior and posterior axillary lines as boundaries, each side of the lung was divided into 3 regions: anterior, lateral and posterior.The probe was held perpendicular or parallel to the ribs, and each region of both sides of the lung was scanned. Results In this study, the main lung ultrasonographic findings in MAS patients were as follows: (1) Lung consolidation with air bronchograms, which was found in all patients.Generally, the large area of lung consolidation with irregular margins was seen in severe MAS patients while the small area of lung consolidation was seen in mild patients.(2)Pleural line anomalies and the disappearance of the A-lines, which were found in all patients.(3)Atelectasis, which was found in 12 severe cases(17.9%), with severe massive atelectasis and visible lung pulse.(4)Pleural effusion, which was found in 9 cases (13.4%) including mild or severe patients.(5)Alveolar-interstitial syndrome (AIS) or B-line in the non-consolidation area was found in all patients. Conclusions There were speci-fic imaging findings in lung ultrasound in MAS patients. Lung ultrasonography can be used for the routine diagnosis of MAS because of its accuracy, reliability, low-cost and simplicity, no risk of radiation damage as well as it is convenience to observe and understand the dynamic changes of the patients′ condition timely. Key words: Lung ultrasonography; Meconium aspiration syndrome; Infant, newborn

Continuous positive airway pressure in meconium aspiration syndrome: An observational study

Background: Continuous positive airway pressure (CPAP) as a treatment modality is well established in respiratory distress syndrome. There is still a lot of skepticism for use of CPAP in meconium aspiration syndrome (MAS). We studied the use of CPAP as a primary treatment modality in MAS and tried to identify factors predicting CPAP failure. Objectives: The aim was to identify failure rates of MAS on bubble or ventilator nasal CPAP and potential predictors of CPAP failures in MAS cases. Design: Multicenter observational analytical study. CPAP failures were compared with CPAP success for perinatal and neonatal variables. Methods: From January 2012 to May 2013, 97 babies were admitted with diagnosis of MAS, out of which 66 babies were enrolled in the study. Bubble or ventilator nasal CPAP was started if the SpO 2 in room air was Results: Sixteen infants (24%) out of 66 failed to CPAP. Reasons for failure were: 10 infants had increased oxygen requirement (7 had persistent pulmonary hypertension and 3 had sepsis with multiorgan dysfunction). Two infants were ventilated for poor efforts (due to recurrent seizures), 3 (4.5%) for worsening pneumothorax and one infant for severe metabolic acidosis. Baseline variables were compared between the infants who failed CPAP and those who were successfully managed with CPAP alone. On univariate analysis, factors significantly associated with CPAP failure were out-born status, abnormal cardiotocograph, high FiO 2 at 1 h and high positive end-expiratory pressure at 1 h ( P P Conclusion: CPAP when applied early may reduce the need for MV in newborns with moderate to severe MAS infants.

Effect Of Nebulized Budesonide In Improving The Clinical Outcome Of Neonates With Meconium Aspiration Syndrome

Aim and Objective: To study the effect of nebulized steroid in improving the clinical outcome in terms of morbidity and mortality in neonates with meconium aspiration syndrome. Patients: Full term babies with clinical diagnosis of Meconium aspiration syndrome(MAS) admitted in the NICU of cheluvamba hospital attached to Mysore medical college and research institute were included in the study. Intervention: Administration of nebulized budesonide(Budecort,Cipla) in a dose of 50µg in 2.5ml normal saline through jet nebulizer every 12hourly from second day of life till 7days or clinical recovery whichever is earlier. Results: 40 patients were randomized into 20 in control group(Group-A) and 20 in budesonide group(Group-B). The baseline clinical profile of both the groups were similar. Duration of respiratory distress in days (2.63vs5.24 p=0.0493), duration of oxygen dependency(2.37vs4.94 p=0.0406), duration of hospital stay(7.58vs10.47 p=0.0430), time taken for achievement of full feeds(3.79vs8.76 p=0.0002) and the need for mechanical ventilation(0vs0.2 p=0.0356) were statistically less in budesonide treated group as compared to the controls. Complications were similar in both the groups. Four patients died during the hospital stay, three in the control group and one in the case group. Out of them, two patients died due to pneumothorax and both of them belong to the control group, other two patients died due to sepsis with disseminated intravascular coagulation(DIC), representing one each from control and case group. Conclusion:Nebulized budesonide improves the short term respiratory outcome and is relatively safe, however long term follow-up is needed to recommend inhalation route of steroids as safe and effective.

Outcomes of neonates with perinatal asphyxia at a tertiary academic hospital in Johannesburg, South Africa

Background. Perinatal asphyxia is a significant cause of death and disability. Aim. To determine the outcomes (survival to discharge and morbidity after discharge) of neonates with perinatal asphyxia at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methods. This was a descriptive retrospective study. We reviewed information obtained from the computerised neonatal database on neonates born at CMJAH or admitted there within 24 hours of birth between 1 January 2006 and 31 December 2011, with a birth weight of >1 800 g and a 5-minute Apgar score <6. Results. Four hundred and fifty infants were included in the study; 185 (41.1%) were females, the mean birth weight (± standard deviation) was 3 034.8±484.9 g, and the mean gestational age was 39.1±2.2 weeks. Most of the infants were born at CMJAH (391/450, 86.9%) and by normal vaginal delivery (270/450, 60.0%). The overall survival rate was 86.7% (390/450). Forty-two infants were admitted to the intensive care unit (ICU). The ICU survival rate was 88.1% (37/42). Significant predictors of survival were place of birth ( p =0.006), mode of delivery ( p =0.007) and bag-mask ventilation at birth ( p =0.040). Duration of hospital stay ( p =0.000) was significantly longer in survivors than in non-survivors (6.5±6.6 days v. 2.8±9.8 days). The remaining factors, namely gender, antenatal care, chest compressions, diagnosis of meconium aspiration syndrome or persistant pulmonary hypertension, did not differ significantly between the two groups. The rate of perinatal asphyxia (5-minute Apgar score <6) was 4.7/1 000 live births, and there was evidence of hypoxic ischaemic encephalopathy (HIE) in 3.6/1 000 live births. Of the 390 babies discharged from CMJAH, 113 (29.0%) had follow-up records to a mean corrected age of 5.9±5.0 months. The majority (90/113, 79.6%) had normal development. Conclusions. ( i ) The high overall survival and survival after ICU admission provides a benchmark for further care; ( ii ) obtaining adequate data for long-term follow-up was not possible with the existing resources – surrogate early markers of outcome and/or more resources to ensure accurate follow-up are needed; and ( iii ) the high incidence of HIE suggests that a therapeutic hypothermia service including a long-term follow-up component would be beneficial.

Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period

The purpose of this study was to evaluate the demographic and treatment characteristics of neonates (>or=37 weeks' estimated gestational age) who were admitted to a neonatal intensive care unit (NICU) for a diagnosis of meconium aspiration syndrome (MAS) during the years 1997 to 2007. The goals in studying this group of neonates were to better estimate the magnitude of abnormal outcomes and to determine the proportion of these infants exposed to specific therapeutic interventions. Retrospective review of an administrative de-identified data set. A total of 415,772 neonates formed the starting data set and 162,075 (39%) were >or=37 weeks. Of the 162,075 term neonates, 7518 (1.8% of all neonates and 4.6% of term NICU admissions) had an admission diagnosis of MAS. In the 7518 neonates, the following outcomes were observed: 6124 (81.5%) were discharged home; 679 (9%) were acutely transferred to a higher level of intensive care; 416 (5.5%) were transferred to another clinical service within the hospital; 178 (2.4%) were transferred to another NICU for convalescent care and 88 (1.2%) died. There were 33 (0.4%) who did not have data on outcome at discharge. During the period between 2002 and 2005, acute transfer rates decreased (12.4 to 9%) and the reported rate for death remained relatively constant between 0.9 and 1.5%. There were 107 (1.4%) neonates who were treated (n=61) with, or transferred, for extracorporeal membrane oxygenation (ECMO) (n=46). Three of the sixty-one neonates (4.9%) who were treated with ECMO died. Term neonates who are admitted with a diagnosis of MAS continue to represent a high-risk population with significant morbidity, and they often require intensive therapies.

Treatment of MAS with PPHN using combined therapy: SLL, bolus surfactant and iNO

The objective of the study was to compare the effectiveness of surfactant treatment either by bolus or surfactant lung lavage followed by inhaled nitric oxide (iNO) therapy in infants with meconium aspiration syndrome (MAS) complicated by persistent pulmonary hypertension (PPHN). In this study, thirteen infants with diagnosis of MAS and PPHN were first treated with conventional respiratory support. Then between 2 and 22h of life they were randomized either to bolus surfactant treatment (n=6) or surfactant lung lavage (SLL, n=7) treatment. Then all infants were treated with iNO therapy. The groups were compared with regard to their clinical course: changes in PaO(2), FiO(2), MAP, OI, A-a oxygen gradient, duration of iNO therapy, length of ventilation and hospitalization. Complications and mortality were also compared. The results showed that infants treated with SLL had significant improvements in oxygenation, decreases in MAP and A-a gradients. But there were no significant differences in duration of ventilation, iNO treatment, length of hospitalization or complications. In conclusion these data show no advantage of SLL therapy over bolus surfactant treatment in infants with MAS complicated by PPHN.

Decreased use of neonatal extracorporeal membrane oxygenation (ECMO): how new treatment modalities have affected ECMO utilization.

Over the last decade, several new therapies, including high-frequency oscillatory ventilation (HFOV), exogenous surfactant therapy, and inhaled nitric oxide (iNO), have become available for the treatment of neonatal hypoxemic respiratory failure. The purpose of this retrospective study was to ascertain to what extent these modalities have impacted the use of neonatal extracorporeal membrane oxygenation (ECMO) at our institution. Patients from 2 time periods were evaluated: May 1, 1993 to November 1, 1994 (group 1) and May 1, 1996 to November 1, 1997 (group 2). During the first time period (group 1), HFOV was not consistently used; beractant (Survanta) use for meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn (PPHN), and pneumonia was under investigation; and iNO was not yet available. During the second time period (group 2), HFOV and beractant treatment were considered to be standard therapies, and iNO was available to patients with oxygenation index (OI) >/=25 x 2 at least 30 minutes apart, or on compassionate use basis. Patients were included in the data collection if they met the following entry criteria: 1) OI >15 x 1 within the first 72 hours of admission; 2) EGA >/=35 weeks; 3) diagnosis of MAS, PPHN or sepsis/pneumonia; 4) <5 days of age on admission; and 5) no congenital heart disease, diaphragmatic hernia, or lethal congenital anomaly. Of the 49 patient in group 1, 21 (42.8%) required ECMO therapy. Of these ECMO patients, 14 (66.6%) had received diagnoses of MAS or PPHN. Only 3 of the patients that went on to ECMO received beractant before the initiation of bypass (14.3%). All ECMO patients in group 1 would have met criteria for iNO had it been available. Of all patients in group 1, 18 (36.7%) were treated with HFOV, and 13 (26.5%) received beractant. Of the 47 patients in group 2, only 13 (27.7%) required ECMO therapy (compared with group 1). Of these ECMO patients, only 5 (38.5%) had diagnoses of MAS or PPHN, with the majority of patients (61.5%) requiring ECMO for sepsis/pneumonia, with significant cardiovascular compromise. Only 5 of these ECMO patients, all outborn, did not receive iNO before cannulation because of the severity of their clinical status on admission. Of all patients in group 2, 41 (87.2%) were treated with HFOV (compared with group 1), 42 (89.3%) received beractant (compared with group 1), and 18 (44.7%) received iNO. The results indicate that ECMO was used less frequently when HFOV, beractant and iNO was more commonly used. The differences in treatment modalities used and subsequent use of ECMO were statistically significant. We speculate that, in this patient population, the diagnostic composition of neonatal ECMO patients has changed over time.

Assisted Ventilation in Infants With Meconium Aspiration Syndrome

In a retrospective analysis of infants born with meconium staining over an 18-month period at Cook County Hospital, 32 infants met two of the three criteria for the diagnosis of meconium aspiration syndrome: (1) history of meconium in the oropharynx or trachea; (2) clinical evidence of respiratory distress; and (3) x-ray evidence of aspiration pneumonia. Seventeen infants developed respiratory failure; nine of these infants died. One infant without respiratory failure died of sepsis. Analysis of sequential arterial blood pH and gas tension showed that nonsurviving infants had persistently high PCO2 and A-a gradient in spite of initiation of assisted ventilation. These changes seem to be related to severe right-to-left shunting and ventilation perfusion abnormalities. The data further suggest that asphyxia and acidosis occur well before the infant is born and that intrapartum monitoring to recognize fetal asphyxia may help in improving morbidity and mortality from meconium aspiration syndrome.