Management Of Meconium Aspiration Syndrome Research Articles

The Effects of Different Types of Steroids on Clinical Outcomes in Neonates with Meconium Aspiration Syndrome: A Systematic Review, Meta-Analysis and GRADE Assessment.

Background and Objectives: Meconium aspiration syndrome (MAS) is a condition caused by the aspiration of meconium-stainted amniotic fluid into the lungs, resulting in pulmonary inflammation, neonatal morbidity, and mortality. It is important that these MAS infants receive appropriate care to avoid further complications. Steroids have an anti-inflammatory effect and may be effective in the management of MAS. The objective of the this study was to evaluate the effect of different steroids on clinical outcomes in infants with MAS. Materials and Methods: We systematically searched of PubMed/Medline, Scopus, Embase, Clinical Trials.gov, and Cochrane Library databases from inception to 24 January 2021 without language restriction. Only randomized controlled trials (RCTs) evaluating the effects of steroids in neonates with MAS were included. We calculated relative risks and weighted mean differences (MDs) with 95% confidence intervals (CIs) using a random-effects model to determine the associations between MAS and steroids and GRADE approach was employed for quality of evidence. The main outcomes measures were duration of respiratory distress, oxygen requirement, hospitalization, need for mechanical ventilation, death, and adverse drug reactions. Results: Seven RCTs involving 397 patients were analyzed. Nebulized budesonide and intravenous (IV) methylprednisolone shortened the duration of respiratory distress (MD, −2.46 days; 95% CI, −3.09 to −1.83 and MD, −3.30 days; 95% CI, −4.07 to −2.52, respectively) (moderate certainty). There was a reduction in duration of oxygen requirement in nebulized budesonide use (MD, −2.40 days; 95% CI, −3.40 to −1.40) (low certainty) and IV methylprednisolone use (MD, −3.30 days; 95% CI, −4.07 to −2.52) (moderate certainty). Nebulized budesonide shortened hospitalization stay (MD, −4.47 days; 95% CI, −8.64 to −0.30 days) (low certainty) as IV methylprednisolone use (MD, −7.23 days; 95% CI, −8.19 to −6.07 days) (moderate certainty). None of steroids benefits in death (low certainty). Conclusions: Certain types of steroids may benefit the respiratory aspect, but there was no decrease in mortality in MAS infants.

PIH24 A CLINICAL AND ECONOMIC EVALUATION OF SURFACTANT THERAPY FOR MECONIUM ASPIRATION SYNDROME IN THE NEONATAL INTENSIVE CARE SETTING IN QATAR

Meconium Aspiration Syndrome (MAS) is a life-threatening condition that can contribute to neonatal mortality. Surfactant replacement therapy is widely used in the management of MAS. The aim of this study was to evaluate the clinical and economic impact of surfactant use versus standard care in MAS management in the neonatal intensive care unit (NICU) setting.

Meconium-stained amniotic fluid as a risk factor for perinatal asphyxia

Background: The aim of this study was to find out immediate fetal outcome in meconium-stained amniotic fluid in relation to perinatal asphyxia.Methods: This retrospective study includes medical records of all neonates admitted to Neonatal Intensive Care Unit (NICU) between December 2016 and July 2018. The variables reviewed are age, sex, weight, mode of delivery, gestational age, presence of meconium aspiration syndrome (MAS) and perinatal asphyxia.Results: Out of 408 total admissions in NICU, 69.1% were male babies and remaining 30.9% were female babies. In the study out of 36 subjects with Perinatal Asphyxia, 38.9% had MAS and 61.1% had not MAS. Out of 372 subjects without perinatal asphyxia, 93.8% had no MAS and 6.2% had MAS. There was significant association between MAS and perinatal asphyxia. Odds ratio was 9.656. i.e. those with MAS had 9.656 times higher risk for perinatal asphyxia.Conclusions: The management of MAS, which is a perinatal problem, requires a well concerted and coordinated action by the obstetrician and pediatrician. Prompt and efficient delivery room management can minimize the sequelae of aspirated meconium and decrease the chance of perinatal asphyxia in the new born babies.

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Meconium aspiration syndrome (MAS) is a major cause of respiratory insufficiency in the term and post-term newborns. There are several pathomechanisms participating in this disorder, particularly the airway obstruction, surfactant dysfunction, inflammation, lung edema, pulmonary vasoconstriction and bronchoconstriction. Inflammatory changes resulting from meconium aspiration cause severe impairment of lung parenchyma and surfactant, and influence the reactivity of both vascular and airway smooth muscle. Therefore, anti-inflammatory drugs may be of benefit in the management of MAS. This article reviews the pharmacological actions and side effects of various anti-inflammatory drugs used up to now in the experimental models of MAS and in the treatment of newborns with meconium aspiration.

Meconium aspiration syndrome: challenges and solutions

Meconium aspiration syndrome: challenges and solutions Ankita Goel, Sushma Nangia Department of Neonatology, Lady Hardinge Medical College and Kalawati Saran Children Hospital, Shaheed Bhagat Singh Marg, New Delhi, India Abstract: Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term newborns. A result of antepartum or postpartum aspiration of meconium stained amniotic fluid (MSAF), MAS causes respiratory distress of varying severity, often complicated by air leaks or persistent pulmonary hypertension (PPHN). There has been a tremendous change in the concepts of pathophysiology and management of MAS over the last few decades. Routine endotracheal suctioning is no longer recommended in both vigorous and nonvigorous neonates with MSAF. Supportive management, along with newer therapies such as surfactant, inhaled nitric oxide, and high-frequency ventilation, has resulted in marked improvement in the overall outcome of MAS. The present review highlights the challenges in understanding the complex pathophysiology and optimal management approach to MAS. Potential future therapies and drugs in trial are also discussed briefly. Keywords: meconium aspiration syndrome, endotracheal suction, surfactant, inhaled nitric oxide, high-frequency ventilation, persistent pulmonary hypertension

Non–Delivery Room Management of Meconium Aspiration Syndrome (MAS)

Meconium aspiration syndrome (MAS) is a common respiratory disorder in term and near-term neonates. Infants with MAS may be extremely ill and need extensive support. This article reviews the clinical presentation of the disorder, the diagnostic evaluation that should be performed, and the ventilatory and medical management of MAS.

Management of the Meconium-Stained Newborn

For infants with meconium-stained amniotic fluid, management has significantly changed over time. The goal of preventing meconium aspiration syndrome (MAS) and its complications led to the initial recommendations in the 1970s and 1980s based on biologic plausibility and nonrandomized studies. The incidence of MAS and mortality related to MAS has progressively declined since the 1970s, most likely because of obstetric practices that have decreased the incidence of birth beyond 41 weeks’ gestation. As the body of evidence evolved, these interventions were abandoned. The latest recommendations for management of MAS are based on multiple large randomized trials and are reflected in the 2015 American Heart Association guidelines.

Current Concepts in the Management of Meconium Aspiration Syndrome.

In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.

Meconium-stained amniotic fluid as a potential risk factor for perinatal asphyxia: A single-center experience

Background: The aim of this study was to find out immediate fetal outcome in meconium-stained amniotic fluid in relation to perinatal asphyxia. Materials and Methods: This retrospective study includes medical records of all neonates admitted to Neonatal Intensive Care Unit (NICU) between September 2014 and July 2015. The variables reviewed are age, sex, weight, mode of delivery, gestational age, presence of meconium aspiration syndrome (MAS) and perinatal asphyxia. Results: Out of 399 total admissions in NICU, 62.4% were male babies and remaining 37.6% were female babies. Of the total 6.8% were cases of MAS, making females (10.7%) more prone compared to male (4.4%) while perinatal asphyxia came out to be 11.5%, making male (12%) more prone than female (10.7%). Postterm (odds ratio [OR] =3.50 [CI: 0.39-31.42]) and term (OR = 2.58 [CI: 1.16, 5.75]) babies were having more risk of developing MAS compared to preterm (P < 0.01). Postterm (OR = 9.15 [CI: 1.91-43.75]) and term (OR = 2.67 [CI: 1.41-5.08]) babies were having more risk of developing perinatal asphyxia compared to preterm (P < 0.01). MAS babies are having 6.62 (CI: 2.85-15.38) times more risk of developing perinatal asphyxia (P < 0.01). Conclusion: The management of MAS, which is a perinatal problem, requires a well concerted and coordinated action by the obstetrician and pediatrician. Prompt and efficient delivery room management can minimize the sequelae of aspirated meconium and decrease the chance of perinatal asphyxia.

PO-0774 Lung Ultrasound Findings In Meconium Aspiration Syndrome

Background and aims Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly used in critical care settings. Specific LUS findings have been described for some types of neonatal lung injury, but no formal data exists on ultrasound imaging of MAS. We here describe ultrasound findings in MAS. Methods Five patients with MAS of variable severity were examined by LUS during the first hours of life, using either a microconvex 7,5 MHz, or a linear 12–18 MHz probe. Chest X-rays were used as reference. Results A range of unevenly distributed dynamic signs was observed in five neonates with MAS (LUS dynamic video recordings will be shown). The following signs were seen in all cases: 1) B-pattern (interstitial) coalescent or sparse; 2) consolidations; 3) atelectasis; 4) bronchograms. No pattern was observed for distribution of signs in lung areas. The signs in the same lung area varied with time, reflecting the changing auscultation patterns. In our opinion, this is due to the changing localisation of meconium and the displacement or dissolution of meconium plugs. LUS images corresponded well with X-ray findings. Conclusions We provide the first formal description of LUS findings in neonates with MAS. LUS seems to be a useful and promising tool in the diagnosis and management of MAS, providing real-time bedside imaging, with the additional potential benefit of limiting radiation exposure in sick neonates. ![Abstract PO-0774 Figure 1][1] Abstract PO-0774 Figure 1 [1]: pending:yes

5ICCN_021: Volume and strain; new methods to explore cardiac physiology in preterm infants with a patent ductus arteriosus

Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly being used in critical care settings, also for newborns. In this paper we describe ultrasound findings in MAS.Six patients with MAS of variable severity were examined by LUS during the first hours of life. Chest X-rays were used as reference.The following dynamic LUS signs were seen in all patients: (1) B-pattern (interstitial) coalescent or sparse; (2) consolidations; (3) atelectasis; (4) bronchograms. No pattern was observed for the distribution of signs in lung areas, although the signs varied with time, probably due to the changing localisation of meconium in the lungs. LUS images corresponded well with X-ray findings.In conclusion, we provide the first formal description of LUS findings in neonates with MAS. LUS is a useful and promising tool in the diagnosis and management of MAS, providing real-time bedside imaging, with the additional potential benefit of limiting radiation exposure in sick neonates.© 2014 Elsevier Ireland Ltd. All rights reserved.

5ICCN_003: Evolution of the heart rate corrected QT interval in premature infants during the first week of life

Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly being used in critical care settings, also for newborns. In this paper we describe ultrasound findings in MAS.Six patients with MAS of variable severity were examined by LUS during the first hours of life. Chest X-rays were used as reference.The following dynamic LUS signs were seen in all patients: (1) B-pattern (interstitial) coalescent or sparse; (2) consolidations; (3) atelectasis; (4) bronchograms. No pattern was observed for the distribution of signs in lung areas, although the signs varied with time, probably due to the changing localisation of meconium in the lungs. LUS images corresponded well with X-ray findings.In conclusion, we provide the first formal description of LUS findings in neonates with MAS. LUS is a useful and promising tool in the diagnosis and management of MAS, providing real-time bedside imaging, with the additional potential benefit of limiting radiation exposure in sick neonates.© 2014 Elsevier Ireland Ltd. All rights reserved.

Lung ultrasound findings in meconium aspiration syndrome

Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly being used in critical care settings, also for newborns. In this paper we describe ultrasound findings in MAS. Six patients with MAS of variable severity were examined by LUS during the first hours of life. Chest X-rays were used as reference. The following dynamic LUS signs were seen in all patients: (1) B-pattern (interstitial) coalescent or sparse; (2) consolidations; (3) atelectasis; (4) bronchograms. No pattern was observed for the distribution of signs in lung areas, although the signs varied with time, probably due to the changing localisation of meconium in the lungs. LUS images corresponded well with X-ray findings. In conclusion, we provide the first formal description of LUS findings in neonates with MAS. LUS is a useful and promising tool in the diagnosis and management of MAS, providing real-time bedside imaging, with the additional potential benefit of limiting radiation exposure in sick neonates.

5ICCN_023: Neonatal mortality in Catalonia from 2011 to 2013

Meconium aspiration syndrome (MAS) is a rare and life-threatening neonatal lung injury induced by meconium in the lung and airways. Lung ultrasound (LUS) is a quick, easy and cheap imaging technique that is increasingly being used in critical care settings, also for newborns. In this paper we describe ultrasound findings in MAS.Six patients with MAS of variable severity were examined by LUS during the first hours of life. Chest X-rays were used as reference.The following dynamic LUS signs were seen in all patients: (1) B-pattern (interstitial) coalescent or sparse; (2) consolidations; (3) atelectasis; (4) bronchograms. No pattern was observed for the distribution of signs in lung areas, although the signs varied with time, probably due to the changing localisation of meconium in the lungs. LUS images corresponded well with X-ray findings.In conclusion, we provide the first formal description of LUS findings in neonates with MAS. LUS is a useful and promising tool in the diagnosis and management of MAS, providing real-time bedside imaging, with the additional potential benefit of limiting radiation exposure in sick neonates.© 2014 Elsevier Ireland Ltd. All rights reserved.

Anti-inflammatory treatment of meconium aspiration syndrome: Benefits and risks

Meconium aspiration syndrome (MAS) is a major cause of respiratory insufficiency in the term and post-term newborns. There are several pathomechanisms participating in this disorder, particularly the airway obstruction, surfactant dysfunction, inflammation, lung edema, pulmonary vasoconstriction and bronchoconstriction. Inflammatory changes resulting from meconium aspiration cause severe impairment of lung parenchyma and surfactant, and influence the reactivity of both vascular and airway smooth muscle. Therefore, anti-inflammatory drugs may be of benefit in the management of MAS. This article reviews the pharmacological actions and side effects of various anti-inflammatory drugs used up to now in the experimental models of MAS and in the treatment of newborns with meconium aspiration.

Advances in the management of meconium aspiration syndrome.

Meconium aspiration syndrome (MAS) is a common cause of severe respiratory distress in term infants, with an associated highly variable morbidity and mortality. MAS results from aspiration of meconium during intrauterine gasping or during the first few breaths. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis with release of vasoconstrictive and inflammatory mediators, and persistent pulmonary hypertension of newborn (PPHN). This disorder can be life threatening, often complicated by respiratory failure, pulmonary air leaks, and PPHN. Approaches to the prevention of MAS have changed over time with collaboration between obstetricians and pediatricians forming the foundations for care. The use of surfactant and inhaled nitric oxide (iNO) has led to the decreased mortality and the need for extracorporeal membrane oxygenation (ECMO) use. In this paper, we review the current understanding of the pathophysiology and management of MAS.

Core Concepts: Meconium Aspiration Syndrome: Pathogenesis and Current Management

Aspiration of meconium produces a syndrome characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of meconium aspiration syndrome (MAS). Most aspiration of meconium probably occurs before birth. Following aspiration, meconium can migrate to the peripheral airway, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of meconium aspiration. MAS can be diagnosed in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the management of MAS. Recent studies suggest that avoidance of postterm delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso- and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction now is reserved only for infants who are depressed or have respiratory distress at birth. Mortality of MAS has improved; the causes of death are related primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.

Role of Steroids on the Clinical Course and Outcome of Meconium Aspiration Syndrome A Randomized Controlled Trial

Meconium aspiration syndrome (MAS) is one of the major causes of severe respiratory distress in the newborn and there is no uniform protocol of management after the development of MAS. The objective of the study was to determine whether systemic and inhalational steroid therapy can alter the clinical course of MAS and improve the outcome without causing any serious adverse effects. A randomized controlled trial was conducted in three groups of MAS over a period of 1 year. Group A (n = 33) served as controls, Group B (n = 34) received systemic methyl prednisolone and Group C (n = 32) received nebulized budesonide both for a period of 7 days starting after 24 h of age. Details of clinical progress were noted during the hospital stay. Follow up for a minimum period of 3 months was done in all. Data were analysed by SPSS 10 software. Student's t and ANOVA were used to assess statistical significance. Patient profile was similar in all the three groups. Period of oxygen dependency and duration of hospital stay was significantly less in the steroid treated groups. Similarly full enteral feeding and radiological clearance of chest could be achieved earlier in groups B and C. No difference between the steroid treated groups could be appreciated by Student's Newman Kuel (SNK) test. Development of sepsis was similar in all the groups and no serious adverse effects were noted in steroid treated groups. Steroids are effective in the management of MAS and route of administration does not have a bearing on the efficacy.

The Effect of Steroids on the Clinical Course and Outcome of Neonates with Meconium Aspiration Syndrome

Meconium Aspiration Syndrome (MAS) is an important cause of neonatal morbidity and mortality. The present study was undertaken to evaluate the role of steroids in the management of MAS. This was a double blinded randomized controlled trial and a prospective Interventional Study over one-year period in the neonatal unit of the Lady Hardinge Medical College and associated Kalawati Saran Children's hospital. Fifty-one babies of MAS which were randomly distributed into three groups, Control, systemic and nebulized steroids. Methyl prednisolone was given i.v. in dose of 0.5 mg/kg/day in two divided doses. Budecort was given by nebulization in dose of 50 microgram 12 hourly. Infants were assessed in terms of duration of stay, oxygen dependence, X-ray clearances and also assessed for short term adverse effects. There was a statistically significant difference in the duration of stay, duration of oxygen dependence and radiological clearance. The use of steroids was not associated with an increased incidence of sepsis. The conclusion is that steroids alter the course of Meconium Aspiration Syndrome and favorably affect the outcome.

Evidence based practice and the prevention and management of meconium aspiration syndrome

Sir: Greenough et al. [3] should be commended for their comparison of current practice for prevention of meconium aspiration syndrome (MAS) and its scientific basis. However, it is surprising that suction of the hypopharynx before the delivery of the shoulders, a widely used technique based on a very weak clinical study, is not discussed more extensively in their paper. Following the publication by Carson et al. [1] in 1976 of a retrospective study with historical controls showing a non significant trend towards a decrease in MAS, the technique became almost universally adopted by obstetricians. Although two subsequent retrospective studies by Falciglia [2] with a design similar to that of Carson’s study, showed no differences in the incidence of MAS with and without prenatal suction, the procedure was recommended by the American College of Obstetricians and Gynecologists (USA) and the American Academy of Pediatrics. Prenatal suction, however, is not a recommendation of the British Council for Neonatal Resuscitation. Recently, we published a large multicentre randomised control trial demonstrating that suctioning of meconium-stained infants before delivery of the shoulders makes no differences in the incidence, severity, and mortality of MAS [4]. Although most likely this study was published after that of Greenough and colleagues survey had been performed, the results of the study were available from the 2002 and 2003 presentations at the Society for Pediatric Research and Society for Maternal Fetal Medicine (USA). We believe that current recommendations for this procedure, performed annually in millions of deliveries all over the world, should be reevaluated.