Incidence Of Meconium Aspiration Syndrome Research Articles

The incidence and determinants of the meconium-aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section: A prospective cross-sectional study in a specialized hospital, south Ethiopia.

Meconium aspiration syndrome is respiratory distress diagnosed in neonates delivered with meconium-stained amniotic fluid that is unexplained by other pathologies. It has severe neonatal respiratory complications and a significant impact on the prevalence of neonatal mortality. To identify the incidence and determinants associated with meconium aspiration syndrome among mothers with meconium-stained amniotic fluid after emergency cesarean section in Wolkite University specialized hospitals in Ethiopia from September 1, 2021, to August 30, 2022. An institution-based cross-sectional study was done prospectively through meticulous chart review and interviews with 275 mothers with meconium-stained amniotic fluid who gave birth with an emergency cesarean section. Data were entered using EpiData 7 and analyzed with SPSS 26. The association between independent variables and the meconium-aspiration syndrome was estimated using an odds ratio with 95% confidence intervals. The statistical significance of the association was declared at a p-value of 0.05. The prevalence of the meconium-aspiration syndrome is 28.7%. The factors associated are: latent phase (AOR: 2.580; 95% CI: 1.126, 5.913), low 1st minute APGAR score (AOR: 2.43; 95% CI: 0.892, 6.625), and thick meconium (AOR: 31.018; 95% CI: 9.982, 96.390). The neonatal death rate associated with meconium aspiration syndrome is 1.8%, and thick meconium contributed to 65% of admissions to the neonatal intensive care unit and all deaths. The incidence of meconium aspiration syndrome is high, and thick meconium, meconium at early labor, and low APGAR scores all contributed to this. Thick meconium has a substantial effect on neonatal mortality and morbidity. Therefore, an improvement in the quality of obstetric and neonatal care through early intervention in the case of thick meconium and meconium in the early phase of labor is recommended.

Clinical characteristics of meconium aspiration syndrome in neonates with different gestational ages and the risk factors for neurological injury and death: A 9-year cohort study.

The presence of meconium is associated with gestational age, and the incidence of meconium aspiration syndrome (MAS) increases with gestational age. Our study compared the differences in the clinical characteristics of patients with MAS at different gestational ages and discussed the risk factors for neurological injury and death from MAS. A total of 294 neonates diagnosed with MAS between 2013 and 2021 were included. Patients were divided into preterm, early-term, full-term, and late-term groups according to gestational age. We compared the patients' basic demographic, treatment, complications, and clinical outcomes in the different groups. We also analyzed the risk factors of neurological injury and death in patients with MAS. The mean age at admission (0.55 ± 0.9 h) was lower and the proportion of cesarean deliveries (90.00%, 27/30) was higher in the preterm group than in the other three groups. There was no statistically significant difference among the four groups regarding 1- and 5-min Apgar scores and the need for delivery room resuscitation. In terms of complications, early-term infants had the highest incidence of neurological injury (52.9%, 27/51), and late-term infants had the highest incidence of pneumothorax (37.8%, 17/45). The overall mortality rate of children with MAS was 7.80% (23/294), and the difference in mortality rates among the four groups was not significant. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were independent risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS. The clinical characteristics of MAS neonates of different gestational age are different mainly in complications. Early-term infants are more likely to complicate with neurological injury, and late-term infants are more likely to complicate with pneumothorax. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were established as risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates.

This study aimed to evaluate the effect of the 2015 Neonatal Resuscitation Program recommendations of no routine endotracheal suctioning for nonvigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. This was a single-center retrospective cohort study. We recorded data on nonvigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n = 95 (before the new guidelines, January 1, 2013-December 31, 2015) and prospective period 2, n = 91 (after the implementation of new guidelines, January 1, 2017-December 31, 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. No significant differences in the occurrence of MAS (11 vs. 17%) (odds ratio [OR] of 1.46 [95% confidence interval [CI]: 0.59-3.55]) or death (1 vs. 3%) (OR of 2.00 [95% CI: 0.18-21.57]) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37 vs. 61%), with an OR of 2.31 (95% CI: 1.10-4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12 vs. 28%) with an OR of 2.03 (95% CI: 1.02-4.51); p-value of 0.05. Our study did not observe a significant difference in the incidence of MAS or death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased. · Nonvigorous neonates born through MSAF who did not undergo ET suctioning soon after birth did not have increased incidence of MAS or death, but had increased NICU respiratory admissions.. · A large Multi-center RCT may give more clear verdict on the outcomes of these newborns..

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Background. Meconium aspiration syndrome (MAS) occurs in approximately 5% of babies born through meconium-stained amniotic fluid. Risk factors associated with severity of MAS in neonates from developing countries has been infrequently described. 
 Objective. To identify incidence and risk factors associated with the severity of MAS in a lower middle-income country. 
 Method. A retrospective descriptive analysis was conducted on records of neonates diagnosed with MAS at four regional hospitals in the eThekwini district of KwaZulu-Natal, South Africa, between 1 January 2015 and 31 December 2017. 
 Results. A total of 187 neonates had been diagnosed with MAS, of whom 157 survived. The overall incidence of MAS was 2 per 1 000 live births. All the neonates were born through thick meconium. The majority (n=119, 63.6%) of patients were male. Asphyxia was documented in 97 cases (51.9%) and was significantly associated with severe disease (p<0.001). Seizures were noted in 91patients (48.7%), of which 86 (94.5%) occurred in neonates with asphyxia. A quarter of the sample (n=47, 25%) were outborn, with severe disease associated significantly with this group (p=0.025). Multiple logistic regression showed that the occurrence of seizures was significantly associated with severe MAS, (adjusted odds ratio = 23.7, 95% confidence interval 7.58 - 97.7; p<0.001). 
 Conclusion. Neonates born through thick meconium, with moderate to severe asphyxia that is associated with seizures are at increased risk of developing severe MAS. Close monitoring of labour in the intrapartum period, early recognition of fetal distress and timely obstetric intervention are crucial to prevent asphyxia.

Is intraparum suctioning is safe in newborn born to mother with meconium stain amniotic liquor

Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. Methods: We designed a prospective quasi randomized control trial, assessor blind, single centre study. 312 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=127), or no suctioning before delivery (n=185). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used. Findings: No significant difference between treatment groups was seen in the incidence of MAS (36 [26.7%] suction vs 36 [19.5%] no suction; p=0.167),mortality in suction (5 [3.91%] vs no suction( 5 [2.74%]; p=0.779, ) or in the duration of ventilation, oxygen treatment, and hospital care.

Prolonged newborns and prolong pregnancy

The article is devoted to the current problems of obstetrics, perinatology and neonatology. The article presents a literary review and covers scientific views on the factors of births and hazardous factors that lead to transfer and prolonged pregnancy. The most common perinatal complications of a delayed pregnancy are stillbirth, asphyxia, and birth trauma. Neonatal morbidity in premature infants is 29% and perinatal mortality is 19%, which is higher than in preterm infants. If the pregnancy is 43 weeks or more, these rates will increase. All of these diseases are associated with a decrease in the fetal resistance to hypoxia due to the large size of the brain and morphological changes in the placenta. Therefore, the incidence of meconium aspiration syndrome and fetal distress syndrome at birth increases, leading to high perinatal morbidity and mortality.

Tracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid

Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartumasphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS.However, conducting tracheal suction may not only be ineffective, it may also delay effective resuscitation, thus prolonging and worsening the hypoxic-ischaemic insult. OBJECTIVES: To evaluate the efficacy of tracheal suctioning at birth in preventing meconium aspiration syndrome and other complications among non-vigorous neonates born through meconium-stained amniotic fluid. We used the standard search strategy of Cochrane Neonatal to search Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 11) in the Cochrane Library; Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Daily and Versions(R) (1946 to 25 November 2020) for randomised controlled trials (RCTs) and quasi-randomised trials. We also searched clinical trials databases and the reference lists of retrieved articles for RCTs and quasi-randomised trials (up to November 2020). We included studies enrollingnon-vigorous neonates born through MSAF, if the intervention being tested included tracheal suction at the time of birth with an intent to clear the trachea of meconium before regular breathing efforts began.Tracheal suction could be performed with an endotracheal tube or a wide-gauge suction catheter. Neonates in the control group should have been resuscitated at birth with no effort made to clear the trachea of meconium. Two review authors independently assessed trial quality and extracted data, consulting with a third review author about any disagreements. We used standard Cochrane methodological procedures, including assessment of risk of bias for all studies. Our primary outcomes were: MAS; all-cause neonatal mortality; and incidence of hypoxic-ischaemic encephalopathy (HIE). Secondary outcomes included: need for mechanical ventilation; incidence of pulmonary air leaks; culture-positive sepsis; andpersistent pulmonary hypertension.We used the GRADE approach to assess the certainty of evidence. We included four studies (enrolling 581 neonates) in the review.All four studies were conducted in tertiary care hospitals in India. Three of the four studies included neonates born at and beyond term gestation, whereas one included neonates born at and beyond 34 weeks of gestation.Due to the nature of the intervention, it was not possible to blind the healthcare personnel conducting the intervention. Tracheal suction compared to no suction in non-vigorous neonates born through MSAF In non-vigorous infants, no differences were noted in the risksof MAS (RR 1.00, 95% CI 0.80 to 1.25; RD 0.00, 95% CI -0.07 to 0.08; 4 studies, 581 neonates) or all-causeneonatal mortality (RR 1.24, 95% CI 0.76 to 2.02; RD 0.02, 95% CI -0.03 to 0.07; 4 studies, 575 neonates) with or without tracheal suctioning. No differences were reported in the risk of any severity HIE(RR 1.05, 95% CI 0.68to 1.63; 1 study, 175 neonates) or moderate to severe HIE (RR 0.68, 95% CI 0.43 to 1.09; 1 study, 152 neonates) among non-vigorous neonates born through MSAF.We are also uncertain as to the effect of tracheal suctionon other outcomes such as incidenceof mechanical ventilation (RR 0.99, 95% CI 0.68 to 1.44; RD 0.00, 95% CI -0.06 to 0.06; 4 studies, 581 neonates), pulmonary air leaks (RR 1.22, 95% CI 0.38 to 3.93; RD 0.00, 95% CI -0.02 to 0.03; 3 studies, 449 neonates),persistent pulmonary hypertension (RR 1.29, 95% CI 0.60 to 2.77; RD 0.02, 95% CI -0.03 to 0.06;3 studies, 406 neonates) and culture-positive sepsis (RR 1.32, 95% CI 0.48 to 3.57; RD 0.01, 95% CI -0.03 to 0.05;3 studies, 406 neonates). All reported outcomes were judged as providing very low certainty evidence. We are uncertain about the effect of tracheal suctionon theincidence of MAS and its complications amongnon-vigorous neonates born through MSAF.One study awaits classification and could not be included in the review.More research from well-conducted large trials is needed to conclusively answer the review question.

Gastric Lavage for Prevention of Feeding Intolerance in Neonates Delivered Through Meconium-Stained Amniotic Fluid: A Systematic Review and Meta-Analysis

The role of gastric lavage in neonates delivered through meconium-stained amniotic fluid remains unclear. This study evaluated the effects of gastric lavage, compared to no gastric lavage, on the incidences of feeding intolerance, respiratory distress, meconium aspiration synd-rome, time to establish breastfeeding, hospitalization and pro-cedure-related complications in late-preterm and term neonates delivered through meconium-stained amniotic fluid. Systematic review and meta-analysis. MEDLINE, EMBASE, CENTRAL, and other databases were searched for randomized controlled trials and quasi-randomized controlled trials using search terms: neonate OR newborn infant, meconium OR meconium-stained amniotic fluid, and lavage OR gastric lavage from inception to May 2020. Data were pooled in RevMan and analyzed in GRADE. Pooled effects (9 randomized controlled trials, number=3668), showed a significant reduction in the incidence of feeding intolerance (relative risk 0.70; 95% confidence interval 0.58,0.85, I2=0) after gastric lavage. No difference was observed for the incidence of meconium aspiration syndrome (4 studies) or procedure-related complications (7 studies). Only one study, reporting the proportion of neonates with low oxygenation (SpO2<85%), did not find any significant difference. No study evaluated the effects of gastric lavage on respiratory distress, breastfeeding, and hospitalization. Low-quality evidence supported the role of gastric lavage for the prevention of feeding intolerance in late-preterm and term neonates born through meconium-stained amniotic fluid. Applicability of results was limited by the high risk of bias. Well-conducted randomized controlled trials with important patient outcomes are needed before recommending the practice of gastric lavage.

Study of early neonatal outcomes in babies delivered through meconium-stained amniotic fluid in a rural teaching hospital

Background: When the fetus is in a state of stress meconium is passed presence of meconium in amniotic fluid is potentially a serious Sign of fatal compromise, frequency of meconium strained amniotic fluid ranges from 5-22%. MSAF results in higher rate of cesarean delivery, NICU admission rate, respiratory distress, PPHN and neonatal death. The primary objectives of the study were to estimate the incidence of Meconium aspiration syndrome &amp; Respiratory distress among babies born through meconium-stained amniotic fluid (MSAF) along with studying the outcomes at the end of 7 days.Methods: This was a prospective study undertaken in mediciti institute of medical sciences, Ghanpur Medchal Mandal from Jan 2018 to June 2019. Data was collected in a predetermined proforma after institutional ethical committee clearance and appropriate informed consent.Results: During this period 1972 neonates were delivered of which 216 babies were born through MSAF. 18 were excluded for non-cephalic presentation, multiple gestation or congenital anomalies.198 babies were included in the study (96 male and 102 female). 18 neonates (10.2%) needed resuscitation at birth. 85 (42.9%) had thick MSAF. 43 of them developed respiratory distress (21.7%). 10 babies were ventilated. Seizures, hyperbilirubinemia, thrombocytopenia were more common among babies with thick MSAF. Mortality was 1%.Conclusions: Thick meconium-stained amniotic fluid was associated with low Apgar score, higher rate of emergency cesarean section and meconium aspiration syndrome. Primigravida mothers, maternal hypothyroidism and oligohydramnios were important risk factors associated with MAS.

Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis

ObjectiveWe aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates.DesignWe conducted a systematic review of non-ETS and ETS in non-vigorous infants...

Meconium aspiration syndrome: incidence, associated risk factors and outcome-evidence from a multicentric study in low-resource settings in Nepal.

The aim of this study was to identify the incidence, risk factors and outcome associated with meconium aspiration syndrome (MAS). An observational study was conducted in 12 public hospitals in Nepal from 1 July 2017 to 29 August 2018. All babies born within the study period were included in the study. Babies who were diagnosed as MAS were designated as outcome. Data were analysed with bivariate analysis followed by multiple regression analysis. The overall incidence of MAS was 2.0 per 1000 livebirths. Babies born at post-term gestation (adjusted odds ratio (AOR) = 2.41; 95% confidence interval (CI): 1.05-5.55), nulliparity (AOR = 2.26; 95% CI: 1.20-4.28), instrumental delivery (AOR = 4.79; 95% CI: 2.52-9.10) and caesarean delivery (AOR = 3.67; 95% CI: 2.29-5.89) were significantly associated with MAS. Babies with MAS had a 10-fold risk for pre-discharge mortality (odds ratio = 9.87; 95% CI: 5.81-16.76). The findings in this study are consistent with that reported in other studies. MAS has a high risk of neonatal mortality. Thus, monitoring during pregnancy and labour is necessary for early identification of high-risk conditions associated with MAS. Strengthening of newborn care services is essential to curtail mortality.

Change in neonatal resuscitation guidelines and trends in incidence of meconium aspiration syndrome in California.

To describe trends in the incidence and severity of meconium aspiration syndrome (MAS) around the release of revised Neonatal Resuscitation Program (NRP) guidelines in 2016. The California Perinatal Quality Care Collaborative database was queried for years 2013-2017 to describe the incidence and outcomes of infants with MAS. Results were analyzed based on both individual years and pre- vs. post-guideline epochs (2013-15 vs. 2017). Incidence of MAS decreased significantly from 2013-15 to 2017 (1.02 to 0.78/1000 births, p < 0.001). Among infants with MAS, delivery room intubations decreased from 2013-15 to 2017 (44.3 vs. 35.1%; p = 0.005), but similar proportion of infants required invasive respiratory support (80.1 vs. 80.8%), inhaled nitric oxide (28.8 vs. 28.4%) or extracorporeal membrane oxygenation (0.81 vs. 0.35%). While the study design precludes confirmation of implementation of the recent NRP recommendation, there was no increase in the incidence or severity of MAS following its release.

Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial.

The current version of Neonatal Resuscitation Program no longer favors routine endotracheal suctioning (ETS) in non-vigorous newborns with meconium-stained amniotic fluid (MSAF) due to possibility of procedure-related harms and questionable benefits. However, it calls for additional research on this procedure to provide a definitive answer. The present study was conducted to evaluate the role of ETS in non-vigorous neonates of ≥ 34weeks' gestation born through MSAF on the incidence of meconium aspiration syndrome (MAS). In this open-label randomized controlled trial, 132 non-vigorous neonates with MSAF were randomized to receive ETS (n = 66) or no-ETS (n = 66) during delivery room resuscitation (DRR). Primary outcome variable was incidence of MAS. Secondary outcome variables were requirement of DRR, need of respiratory support, development of complications, duration of hospitalization, and mortality. Both the groups were comparable with respect to maternal and neonatal characteristics. Incidence of MAS was 21 (31.8%) and 15 (22.7%) cases in ETS and no-ETS groups, respectively (relative risk (RR), 1.400, 95% confidence interval (CI), 0.793-2.470). The two groups did not differ with regard to DRR, need for respiratory support, and development of complications. Nine (13.6%) neonates in ETS group, and 5 (7.5%) in no-ETS group died (p > 0.05). Median (interquartile range) duration of hospital stay was 54 (31-141)h and 44 (26-102)h in ETS and no-ETS groups, respectively (p > 0.05).Conclusions: Routine ETS at birth is not useful in preventing MAS in non-vigorous neonates of ≥ 34weeks' gestation born through MSAF.Trial registration: Clinical Trials Registry of India (CTRI/2015/04/008819).What is Known:• Routine endotracheal suctioning is of questionable benefit in non-vigorous newborns with meconium stained amniotic fluid and may have a possibility of procedure-related harms.What is New:• Routine endotracheal suctioning at birth is not useful in preventing meconium aspiration syndrome in non-vigorous newborns of ≥ 34 weeks' gestation born through meconium stained amniotic fluid.

Investigation of in-patient neonatal death at 18 hospitals in Henan Province

Objective To investigate the situation and the causes of neonatal death in Henan Province. Methods This study retrospectively analyzed the clinical data of 277 neonates who died at 18 hospitals in Henan Province in 2017. Distribution and causes of neonatal deaths, differences between perinatal conditions of premature and term/post-term infants, causes of early (<7 d) and late (7-28 d) neonatal deaths and the differences in neonatal death cases between Maternal and Child Health Care Hospitals and General/Children's Hospitals were analyzed. We used t, rank-sum and Chi-square test (or corrected Chi-square test, or Fisher's exact test) for statistical analysis. Results (1) A total of 50 993 newborns were admitted to the 18 hospitals in 2017, 297 of which died with a mortality of 5.82‰. After excluding 20 cases with uncertain birth or maternal pregnancy history or clinical data, 277 cases with complete data were analyzed. Among them, 168 (60.6%) were preterm neonates and 109 (39.4%) were term/post-term ones. Early and late neonatal deaths accounted for 74.0% (205 cases) and 26.0% (72 cases), respectively. (2) The top five causes of neonatal deaths were infection (78 cases, 28.2%), asphyxia (54 cases, 19.5%), neonatal respiratory distress syndrome (NRDS, 33 cases, 11.9%), severe congenital malformations (26 cases, 9.4%) including cyanotic congenital heart diseases, digestive malformations, airway malformations and neural tube defects and pulmonary hemorrhage (23 cases, 8.3%). Among them, the top three causes of early neonatal deaths were asphyxia (48 cases, 23.4%), infection (43 cases, 21.0%) and NRDS (33 cases, 16.1%), while the main causes of late neonatal deaths were infection (35 cases, 48.6%), major congenital malformations (9 cases, 12.5%) and chromosome abnormities/inherited metabolic diseases (7 cases, 9.7%). (3) Maternal complications during pregnancy accounted for 79.1% (219 cases) and the predominant types were pregnancy-induced hypertension (43 cases, 19.6%), followed by infection (36 cases, 16.4%), placental-related conditions (32 cases, 14.6%), gestational diabetes mellitus (23 cases, 10.5%), hypothyroidism (20 cases, 9.1%), fetal distress (18, 8.2%), twin-twin transfusion syndrome (10 cases, 4.6%) and cholestasis syndrome (9 cases, 4.1%). (4) Compared with the term/post-term cases, the preterm cases had higher proportions of multiple births [27.4% (46/168) vs 6.4% (9/109), χ2=14.016, P<0.05], assisted reproduction [7.1% (12/168) vs 0.9% (1/109), χ2=4.421, P<0.05] and maternal hypertensive disorders of pregnancy [21.4% (36/168) vs 6.4% (7/109), χ2=11.353, P<0.05], infection [16.7% (28/168) vs 7.3% (8/109), χ2=4.295, P<0.05] and twin-to-twin transfusion syndrome [6.0% (10/168) vs 0.0% (0/109), χ2=6.707, P<0.05]. (5) Among all the early neonatal deaths, preterm cases had a higher incidence of NRDS than term/post-term neonates [20.3% (27/133) vs 8.3% (6/72), χ2=11.937, P<0.05], but lower incidence of meconium aspiration syndrome (MAS), severe congenital malformations and chromosome abnormalities/inherited metabolic diseases [0.8% (1/133) vs 5.6% (4/72), χ2=4.508; 3.8% (5/133) vs 16.7% (12/72), χ2=10.233; 1.5% (2/133) vs 6.9% (5/72), χ2=4.172; all P<0.05]. Among the late neonatal deaths, the incidence of severe intracranial hemorrhage in preterm infants was higher than that in term/post-term neonates [7.1% (3/42) vs 0.0% (0/30), χ2=2.205, P<0.05]. (6) Compared with the cases in General/Children's Hospitals, those in Maternal and Child Health Care Hospitals showed a higher proportion of preterm neonatal deaths [67.3% (105/156) vs 52.1% (63/121), χ2=6.010, P<0.05], younger gestational age [(32.8±5.3) weeks vs (34.6±4.9) weeks, t=3.072, P<0.05], lower birth weight [(2 132.6±1 014.5) g vs (2 409.4±987.3) g, t=2.513, P<0.05], and higher average age of death [M (P25-P75), 3 (1-8) d vs 2 (1-4) d, Z=3.710, P<0.05]. Conclusions Neonatal death occurs mainly within one week after birth in those with maternal complications. Late preterm deaths and term/post-term cases account for nearly half of total neonatal deaths. The causes of death for preterm and term/post-term newborns vary with postnatal age. Infection, asphyxia and severe congenital malformations are important causes of neonatal deaths. Key words: Infant mortality; Cause of death; Inpatients; Retrospective studies

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

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.

Measuring Meconium Aspiration Syndrome With Discharge Data [31N

INTRODUCTION: Discharge data (International Classification of Diseases ICD codes) have not been used to estimate population level incidence of meconium aspiration syndrome (MAS) in the U.S. Existing population estimates are at least 15 years old and based on vital statistics data which are no longer collected. Estimates from other nations have used combined and disparate ICD codes (“with” and “without” respiratory symptoms). METHODS: We compared MAS diagnoses “with” and “without” respiratory symptoms using nationally representative newborn hospital discharges 2010-2012 (Nationwide Inpatient Sample-KIDS data). We compared incidence and outcomes of each MAS diagnosis controlling for demographic and hospital characteristics. RESULTS: Incidence of MAS with symptoms was 2.49/1000; 1.15/1000 without symptoms. Almost 1/3 (32%) of MAS cases identified by ICD codes were “without respiratory symptoms.” Odds ratio of MAS with symptoms was 1.54 (95% C-I 1.39-1.73) for African American newborns compared to whites. Length of stay was nearly twice as long (6.68 versus 3.65 days) and total charges were nearly 3 times higher ($44,000 versus $15,461) for newborns with symptoms than those without. Crude and adjusted OR's for hypoxic ischemic encephalopathy, pulmonary hypertension of the newborn, facility transfers and mortality are attenuated when disparate ICD codes are combined compared to cases “with symptoms” alone. CONCLUSION: ICD codes for MAS represent very different diseases or disease severity. Discharge data is useful in providing population estimates of MAS incidence, but diagnosis severity should be clearly distinguished by researchers. Combining disparate MAS diagnoses misrepresents incidence and disease severity, complicating population level comparisons and prevention strategies.

Pregnancy-induced hypertension is an independent risk factor for meconium aspiration syndrome: A retrospective population based cohort study

ObjectiveMeconium aspiration syndrome (MAS), possibly resulting from fetal hypoxia, is a respiratory distress disorder in the infant. Pregnancy-induced hypertension (PIH) can cause placental dysfunction and lead to fetal hypoxia, which may induce the development of MAS. Therefore, the aim of this study was to determine the association between PIH and MAS and to identify the predictive risk factors. Materials and methodsThis was a retrospective cohort study. We selected patients with newly diagnosed PIH and a matched cohort group from the Taiwan National Health Insurance Research Database (NHIRD), from January 1, 2000 till December 31, 2013. For each patient in the PIH cohort, 4 subjects without PIH, matched for age and year of delivery, were randomly selected as the comparison cohort. The incidence of meconium aspiration syndrome was assessed in both groups. ResultsAmong the 23.3 million individuals registered in the NHIRD, 29,013 patients with PIH and 116,052 matched controls were identified. Patients who experienced PIH had a higher incidence of MAS than did those without PIH. According to a multivariate analysis, PIH (odds ratio [OR] = 1.70, 95% confidence interval [CI] = 1.49–1.93, p < 0.0001) was independently associated with increased risk of MAS. Additionally, age ≥30 years (OR = 1.26, 95% CI = 1.12–1.42, p = 0.0001), nulliparity (OR = 1.13, 95% CI = 1.01–1.27, p = 0.0367) and patients with diabetes mellitus (OR = 3.09, 95% CI = 1.35–7.09, p = 0.0078) were also independent risk factors of MAS. ConclusionPatients with PIH obtained higher subsequent risk for the development of MAS than those without PIH. Besides, age ≥30 years, nulliparity and patients with diabetes mellitus are the independent risk factors of developing MAS.

Meconium aspiration syndrome: clinical profile, risk factors and outcome in central India

Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disease affecting some neonates born through meconium-stained amniotic fluid (MSAF). MSAF complicates delivery in approximately 8% to 25% of live births, of which nearly 5% of the neonates born through MSAF develop MAS. The present study was undertaken to find out the prevalence of MSAF and MAS and to study the etiology, risk factors, clinical profile and outcome of MAS.Methods: By purposive sampling technique, all newborns, fulfilling the inclusion criteria during one year of study period were enrolled in this hospital based cross-sectional observational study. Risk factors and clinical profile were compared between those who died and survived.Results: Out of 8765 deliveries in hospital 1220 neonates were born with MSAF of which 94 neonates had MAS. Thereby, incidence of MSAF was 13.9% and incidence of MAS out of MSAF was 7.7 %. Of the 94 neonates who had MAS 13.82% died. Almost 3/4th of the MAS neonates were term and AGA. MAS were more common in primigravida mother (68%) and LSCS deliveries (53.2%). Of the total MAS 54.2% had thick meconium in whom mortality was 92.3%. The mortality in MAS cases was significant in low 5-minute APGAR score and non-vigorous baby.Conclusions: Since MSAF is associated with higher morbidity and mortality, if the knowledge of risk factors is known to health care personnel then timely referral or intervention can help in decreasing MAS and its complications.

Delivery Room Management of Meconium-Stained Newborns and Respiratory Support.

In this multicenter cohort study, we compare 130 nonvigorous newborns born during the retrospective 1-year period before the implementation of new NRP guidelines (October 1, 2015, to September 30, 2016) to 101 infants born during the 1-year prospective period after implementation (October 1, 2016, to September 30, 2017). Endotracheal suctioning was performed predominantly in the retrospective group compared with the prospective group (70% vs 2%), indicating the change in practice. A significantly higher proportion of newborns were admitted to the NICU for respiratory issues in the prospective group compared with the retrospective group (40% vs 22%) with an odds ratio (OR) of 2.2 (95% confidence interval [CI]: 1.2-3.9). Similarly, a significantly higher proportion of infants needed oxygen therapy (37% vs 19%) with an OR of 2.5 (95% CI: 1.2-4.5), mechanical ventilation (19% vs 9%) with an OR of 2.6 (95% CI: 1.1-5.8), and surfactant therapy (10% vs 2%) with an OR of 5.8 (95% CI: 1.5-21.8). There were no differences in the incidence of other outcomes, including meconium aspiration syndrome. The recent NRP guideline change was not associated with an increased incidence of meconium aspiration syndrome but was associated with an increased incidence of NICU admissions for respiratory issues. Also, the need for mechanical ventilation, oxygen, and surfactant therapy increased.

Intrapartum oropharyngeal and nasopharyngeal suctioning in neonates born through meconium-stained amniotic fluid: Indian scenario

Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS.Methods: A prospective quasi randomized control trial, assessor blind, single centre study was done at Department of neonatology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan. Patients were enrolled over a total period of 16 months started from January 2016 to April 2017. 312 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=127), or no suctioning before delivery (n=185). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used.Results: No significant difference between treatment groups was seen in the incidence of MAS [36 (26.7%) suction versus 36 (19.5%) no suction; p = 0.167], mortality in suction [5 (3.91%) versus no suction 5 (2.74%); p = 0.779], or in the duration of ventilation, oxygen treatment, and hospital care. There was statistically significant difference in need for mechanical ventilation for MAS [13 (10.23%) vs 4 (2.2%); p = 0.005], any respiratory support for MAS 25 (19.7%) suction versus 18 (9.7) p = 0.019).Conclusions: Routine intrapartum suctioning of infants born through MSAF does not reduce the incidence of MAS. On the contrary, intrapartum suctioning might result in complications like more infant required neonatal resuscitation and respiratory support.