Neonatal Meconium Aspiration Syndrome Research Articles

Impact of perinatal factors on meconium aspiration syndrome in full-term newborns and the construction of a column chart prediction model: An observational study.

To explore the influence of perinatal-related factors on meconium aspiration syndrome (MAS) in full-term neonates and construct a nomogram prediction model for risk stratification of neonatal MAS and adoption of preventive measures. A total of 424 newborns and their mothers who were regularly examined at our hospital between January 2020 and December 2023 who had meconium-contaminated amniotic fluid during delivery were retrospectively selected as participants. Neonates were divided into MAS and non-MAS groups based on whether MAS occurred within 3 days after birth. Data from the 2 groups were analyzed, and factors influencing MAS were screened using multivariate logistic regression analysis. The R3.4.3 software was used to construct a nomogram prediction model for neonatal MAS risk. Receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the performance of the model, and its clinical effectiveness was evaluated using a decision curve. Among the 424 neonates with meconium-stained amniotic fluid, 51 developed MAS within 3 days of birth (12.03%). Multivariate logistic regression analysis showed that a low amniotic fluid index before delivery (OR = 2.862, P = .019), advanced gestational age (OR = 0.526, P = .034), cesarean section (OR = 2.650, P = .013), severe amniotic fluid contamination (OR = 4.199, P = .002), low umbilical cord blood pH (OR = 2.938, P = .011), and low neonatal Apgar 1-min score (OR = 3.133, P = .006) were influencing factors of MAS in full-term neonates. Based on the above indicators, a nomogram prediction model for MAS risk of full-term newborns was constructed. The area under the ROC curve of the model was 0.931. The model was also tested for goodness-of-fit deviation (χ2 = 3.465, P = .903). Decision curve analysis found that the model was clinically effective in predicting the net benefit of MAS risk in neonates with meconium-stained amniotic fluid. The construction of a column chart prediction model for neonatal MAS risk based on prenatal amniotic fluid index, gestational age, delivery method, amniotic fluid contamination level, newborn umbilical blood pH value, and Apgar 1-min score has a certain application value.

Improved neonatal outcomes by multidisciplinary simulation-a contemporary practice in the demonstration area of China.

Simulation-based training improves neonatal resuscitation and decreases perinatal mortality in low- and middle-income countries. Interdisciplinary in-situ simulation may promote quality care in neonatal resuscitation. However, there is limited information regarding the effect of multidisciplinary in-situ simulation training (MIST) on neonatal outcomes. We aimed to investigate the impact of MIST on neonatal resuscitation in reducing the incidence of neonatal asphyxia and related morbidities. Weekly MIST on neonatal resuscitation has been conducted through neonatal and obstetrical collaboration at the University of Hong Kong-Shenzhen Hospital, China, since 2019. Each simulation was facilitated by two instructors and performed by three health care providers from obstetric and neonatal intensive care units, followed by a debriefing of the participants and several designated observers. The incidence of neonatal asphyxia, severe asphyxia, hypoxic-ischemic encephalopathy (HIE), and meconium aspiration syndrome (MAS) before (2017-2018) and after (2019-2020) the commencement of weekly MIST were analyzed. There were 81 simulation cases including the resuscitation of preterm neonates of different gestational ages, perinatal distress, meconium-stained amniotic fluid, and congenital heart disease with 1,503 participant counts (225 active participants). The respective incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS decreased significantly after MIST (0.64%, 0.06%, 0.01%, and 0.09% vs. 0.84%, 0.14%, 0.10%, and 0.19%, respectively, all P < 0.05). Weekly MIST on neonatal resuscitation decreased the incidence of neonatal asphyxia, severe asphyxia, HIE, and MAS. Implementation of regular resuscitation simulation training is feasible and may improve the quality of neonatal resuscitation with better neonatal outcomes in low- and middle-income countries.

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.

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. &#x0D; Objective. To identify incidence and risk factors associated with the severity of MAS in a lower middle-income country. &#x0D; 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. &#x0D; 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&lt;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&lt;0.001). &#x0D; 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.

Neonates Born Through Meconium-stained Amniotic Fluid among Deliveries in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

The mortality and morbidity of meconium aspiration syndrome in neonates born with meconium-stained amniotic fluid in developing countries are still high. In Nepal, few studies have estimated the prevalence of meconium-stained amniotic fluid among newborns. The study aimed to find out the prevalence of neonates born through meconium-stained amniotic fluid among deliveries in a tertiary care centre. This descriptive cross-sectional study was conducted among neonates born in a tertiary care centre from November 2021 to March 2022. Neonates born during the study period with meconium-stained amniotic fluid were studied. Ethical approval was obtained from the Institutional Review Committee. Convenience sampling method was used. With permission from the Department of the Neonatal Intensive Care Unit, the data were collected and entered in a Microsoft Excel sheet. Point estimate and 95% Confidence Interval were calculated. Among 576 neonates, the prevalence of neonates born through meconium-stained amniotic fluid was 77 (13.37%) (10.59-16.15, 95% Confidence Interval). The prevalence of neonates born through meconium-stained amniotic fluid was found to be similar to other studies done in similar settings. meconium; neonate; Nepal.

Morbidity, Mortality Patterns and Factors Associated With Mortality among Neonates Admitted in Wajir County Referral Hospital

Background: Neonatal morbidity and mortality is a global burden despite management measures that has been developed. Approximately 75% of all newborn deaths occur in the first week of life. In 2018 alone, around 2.5 million neonates died globally as a result of preventable causes such as prematurity, complications at birth, infections, and congenital abnormalities. Objective: The objective of the study was to determine neonatal morbidity and mortality patterns, and factors associated with mortality among neonates admitted in Wajir County Referral Hospital. Methodology: A hospital-based retrospective cross-sectional study was conducted among all neonates admitted to the New Born Unit of the WCRH from 01 January 2019 to 31 December 2020. A consecutive sampling technique based on the inclusion criteria was used. A data abstraction tool was used to extract data from the medical records of neonates admitted to the New Born Unit of the hospital. Results: A total of 615 neonates were included in the study. There were 336 (54.6%) male and 279 (45.4%) female neonates. Almost all the deliveries 566 (92.0%) were performed at the health facility with a minority of about 49 (8%) delivered at home. The home deliveries and referrals admissions from tertiary hospitals together were 66 (10.7%). Neonatal morbidity included birth asphyxia 335 (54.5%), neonatal sepsis 144 (23.4%), 57 (9.3%) meconium aspiration syndrome and 52 (8.5%) low birth weight/preterm. Overall mortality in 2019 at the health facility was 45 (12.97%) and in 2020, 35 (13.06%) presenting no significant difference. The deaths that occurred in the first 24 hours of life was 36 (45%). Bivariate and multivariate analysis produced a significant association between the factors associated with neonatal mortality. The multivariate analysis with day of admission (OR 2.872, 95% CI 1.293, 6.375), Sex, (OR 1.02, 95% CI 1.0.627, 1.66) and Birth weight, (OR 0.936, 95% CI 0.423, 2.068) at p&lt;0.05. The logistic regression model was statistically significant, χ2(7) = 20.770, p &lt;0.001. The model explained 27% (Nagelkerke R2) of the variance in discharge outcome and correctly classified 87% of cases. The male gender were 1.02 times more likely to die than females while the place of delivery was 0.572 times likely to result in death. Conclusions: Birth asphyxia was found to be the leading cause of admission, followed by neonatal sepsis and meconium aspiration syndrome respectively. The leading cause of death was birth asphyxia and neonatal sepsis. The mortality rate at the facility was 13%. Neonatal fatality of the newborns admitted to NBU is high in Wajir County. Since majority of the deaths are from preventable causes, this offers chances to improve newborn survival. Key Words: Morbidity, Mortality, Neonates, Asphyxia

A Study of Pregnancies Complicated by Decreased Amniotic Fluid with Maternal and Fetal Outcome in Combined Military Hospital Dhaka

Introduction: Decreased amniotic fluid volume below the normal range expected for the gestational age is a challenging entity encountered by obstetricians. Normal range of amniotic fluid is Amniotic Fluid Index (AFI) 8-20cm. Amniotic Fluid Index (AFI) is a quantitative estimation of amniotic fluid volume seen and measured by ultrasonography during pregnancy. AFI is the sum of the deepest vertical pocket of fluid, excluding fetal parts and umbilical cord, in four quadrants between the maternal midline vertically and transverse line half way between the pubic symphysis and uterine fundus. Decreased AFI has different etiology, pathophysiology, presentation and effect on fetomaternal outcome. Objectives: To assess the incidence, aetiology, time and mode of delivery as well as to evaluate fetomaternal outcome associated with decreased amniotic fluid. Materials and Methods: Prospective observational study was carried out among 60 cases of pregnancy at 3rd trimester with decreased amniotic fluid index admitted in the Department of Obstetrics and Gynaecology, Combined Military Hospital, Dhaka Bangladesh from October 2012-March 2013. Amniotic fluid index was determined by the four quadrant ultrasonography technique on admission. Variables used are parity, gestational age, AFI, the colour of amniotic fluid, etiology and mode of delivery. Neonatal outcome variables were birth weight, APGAR scores at Iand 5 minutes and admission to the neonatal intensive care unit. Results: This study showed that 6% of the admitted patients were presented with decreased amniotic fluid. Among them 42% were borderline and 58% were severe oligohydramnios. Termination by caesarean section is high especially among the severe oligohydramnios patients 29 of 34. High rate of caesarean section is primarily due to fetal distress 60%. There was no maternal morbidity but there was 32% fetal morbidity. Conclusion: Decreased amniotic fluid volume has no significant effect or maternal morbidity other than increased rate of caesarean section, however there was significant neonatal morbidity mainly due to birth asphyxia, others are neonatal sepsis and meconium aspiration syndrome. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 67-70

MATERNAL AND FETAL OUTCOME IN PREGNANCY BEYOND THE EXPECTED DATE OF DELIVERY IN A TERTIARY CARE HOSPITAL OF NEPAL

Background: The risk to the mother and the fetus increase with advancing gestation age. Our study aims to study the maternal and fetal outcome in pregnancy extending beyond the expected date of delivery so that safe timings of induction and appropriate mode of delivery can be determined. Methods: We conducted a retrospective study of 152 patients with pregnancy beyond the expected date who presented to the department of Obstetrics and Gynecology, College of Medical Sciences Teaching Hospital from the time period of October 2019- November 2021.The primary outcome measures were obtained in terms of rate of cesarean section, postpartum hemorrhage, wound infection, admission in neonatal intensive care unit, birth asphyxia and meconium aspiration syndrome. Statistical analysis was performed using Chi-square test with P value &lt;0.05. Results: The majority of 86 (56.58%) patients were between 40-41 weeks of gestation. Maximum number of vaginal deliveries were seen between 40-41weeks (77.90%). Overall cesarean section rate was 40.13% with maximum number between 41-42 weeks (64.28%). Fetal distress with meconium-stained liquor was the most common indication (36.06%). The rate of neonatal intensive care unit admission was 16.44% with birth asphyxia (12.50%) and meconium aspiration syndrome (8.55%) as the primary cause for admission. Maternal complications like oligohydramnios, postpartum hemorrhage, wound infection, cervical tear, shoulder dystocia was seen in 16.45%, 1.97%, 1.97%, 2.63% and 1.31% respectively. Conclusions: The pregnancy beyond the expected date causes definite risk to the mother and the fetus. Therefore, strict fetal surveillance with early induction of labor prior to expected date of delivery is recommended for better fetomaternal outcomes.

Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid

To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF). A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF. Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05). Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.

Efficacy of synthetic surfactant (CHF5633) bolus and/or lavage in meconium-induced lung injury in ventilated newborn rabbits.

The pathogenesis of neonatal meconium aspiration syndrome (MAS) involves meconium-induced lung inflammation and surfactant inactivation. Bronchoalveolar lavage (BAL) with diluted surfactant facilitates the removal of meconium. CHF5633, one of the most promising synthetic surfactants, is effective in neonatal respiratory distress syndrome. Here we investigated its efficacy via BAL in an experimental MAS model. Experimental MAS was induced at birth in near-term newborn rabbits by intratracheal instillation of reconstituted human meconium. First, undiluted CHF5633 was compared with a porcine-derived surfactant (Poractant alfa) via intratracheal bolus (200 mg/kg). Second, the efficacy of BAL with diluted CHF5633 (5 mg/mL, 20 ml/kg) alone, or followed by undiluted boluses (100 or 300 mg/kg), was investigated. Meconium instillation caused severe lung injury, reduced endogenous surfactant pool, and poor survival. CHF5633 had similar benefits in improving survival and alleviating lung injury as Poractant alfa. CHF5633 BAL plus higher boluses exerted better effects than BAL or bolus alone in lung injury alleviation by reversing phospholipid pools and mitigating proinflammatory cytokine mRNA expression, without fluid retention and function deterioration. CHF5633 improved survival and alleviated meconium-induced lung injury, the same as Poractant alfa. CHF5633 BAL plus boluses was the optimal modality, which warrants further clinical investigation. To explore the efficacy of a synthetic surfactant, CHF5633, in neonatal lung protection comparing with Poractant alfa in a near-term newborn rabbit model with meconium-induced lung injury. Similar effects on improving survival and alleviating lung injury were found between CHF5633 and Poractant alfa. Optimal therapeutic effects were identified from the diluted CHF5633 bronchoalveolar lavage followed by its undiluted bolus instillation compared to the lavage or bolus alone regimens. Animals with CHF5633 lavage plus bolus regimen exerted neither substantial lung fluid retention nor lung mechanics deterioration but a trend of higher pulmonary surfactant-associated phospholipid pools.

Umbilical Cord Blood Acid-Base Parameters and Lactate as Predictors of Subsequent Meconium Aspiration Syndrome in Neonates.

Meconium aspiration syndrome (MAS) in neonates born through meconium-stained amniotic fluid (MSAF) causes significant morbidity and mortality. Early recognition of at-risk neonates could help optimize treatment. The aim was to determine predictive characteristics of cord blood pH, base deficit and lactate with subsequent MAS. Receiver operating characteristic (ROC) curves with area under curve (AUC) were estimated. Among 231 MSAF complicated pregnancies, 25 (10.8%) had MAS. Mean cord pH was significantly lower in neonates with MAS compared to those without MAS (7.15 ± 0.11 vs. 7.26 ± 0.07; p < 0.001). Median lactate between the two groups [5.6 (7.5, 3.7) vs. 2.7 (4.5, 2.0)] and base deficit [-10.6 (-13.2, -4.2) vs. -3.7 (-6.3, -2.6)] also differed significantly (p = 0.01). ROC curve area for cord lactate, pH, and base deficit were 0.81, 0.79, and 0.75, respectively. The predictive cutoff values for pH, lactate, and base deficit were 7.20, 3.55mmol/L, and -5.3mmol/L, respectively.

Maternal risk factors and meconium stained amniotic fluid

Background: Meconium is a sterile, thick, black-green, odourless material that results from accumulation of debris in fetal intestine during the third month of gestation. The risk factors for meconium-stained amniotic fluid (MSAF) are both maternal and fetal. MSAF is associated with higher rate of caesarean delivery, increased need for neonatal resuscitation and meconium aspiration syndrome. This observational study was undertaken so that such expecting mothers can be screened at an early stage and prompt intervention can be done to minimize neonatal morbidity and mortality.Methods: This prospective observational study was conducted in department of paediatrics of Sri Guru Ram Das University from December 2014 to June 2016 included all deliveries with meconium stained amniotic fluid excluding Twins, neonates with congenital malformations, multi organ dysfunction or requiring surgical intervention.Results: The incidence of MSAF was 3.42% with 10.5% mortality. Various maternal factors including multiparity, bad obstetric history, pregnancy-induced hypertension (PIH), intrauterine growth restriction (IUGR), maternal diabetes, anaemia and non-reassuring cardiotocography (CTG) record were found to be statistically important and associated with poor outcome.Conclusions: MSAF and poor neonatal outcome is related to antenatal care. Thus, good antenatal and perinatal care can prevent morbidity and mortality in neonate by early identification of signs of fetal distress and passage of meconium inutero and improve outcome.

A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates.

To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF). A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage. There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05]. Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.

The clinical effects of high-frequency oscillatory ventilation in the treatment of neonatal severe meconium aspiration syndrome complicated with severe acute respiratory distress syndrome

ObjectiveTo explore the efficacy and safety of high-frequency oscillatory ventilation (HFOV) in the treatment of severe meconium aspiration syndrome (MAS) complicated with severe acute respiratory distress syndrome (ARDS).MethodsA total of 65 infants with severe MAS complicated with severe ARDS were included in the study. The clinical efficacy of treatment for the HFOV group (n = 31) and the conventional mechanical ventilation (CMV) group (n = 34) was retrospectively analysed. The partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2), PaO2/fraction of inspired oxygen (FiO2), and oxygen index values before and at 6, 12, 24, 48, and 72 h after mechanical ventilation, the mechanical ventilation time, oxygen inhalation time, incidence of complications, and outcomes of the two groups were compared.ResultsAt 6, 12, 24, and 48 h after mechanical ventilation, the PaO2 in the HFOV group was significantly higher than in the CMV group, while the PaCO2 in the HFOV group was significantly lower than in the CMV group (P < 0.05). At 6, 12, 24, 48, and 72 h after mechanical ventilation, PaO2/FiO2 in the HFOV group was significantly higher than in the CMV group, and the OI in the HFOV group was significantly lower than in the CMV group (P < 0.05). Mechanical ventilation time, oxygen inhalation time, and the incidence of air leakage were significantly lower in the HFOV than in the CMV group (P < 0.05).ConclusionsOverall, HFOV can effectively improve lung ventilation and oxygenation function, shorten ventilator treatment time, and reduce the incidence rate of air leakage for neonatal MAS, making it a safe and effective treatment option.

Efficacy and Safety of Vaginal Misoprostol for Cervical Ripening and Labour Induction in Late Pregnancy

Background: Induction of labor is its intentional initiation before spontaneous onset, with the aim of vaginal birth which is safe for mother and newborn. The well documented effectiveness of misoprostol in several gynecological and obstetric applications has resulted in enthusiasm for its use. Objective: To see the efficacy and safety vaginal Misoprostal for cervical ripening and labour induction in late pregnancy. Materials and Methods: This single center clinical trial was carried out in the Department of Obstetrics and Gynaecology at Khwaja Yunus Ali Medical College and Hospital in Sirajgonj, Bangladesh from June 2019 to May 2020 for a period of one year. A total of 90 women requiring indicated induction of labour with an unfavourable cervix (Bishop score ≤ 4) were included in the study. They were randomly divided into two groups: 53 women induced with intravaginal misoprostol (Group I) and 37 women induced with transcervical Foley catheter (Group II). Results: Spontaneous vaginal delivery was 35(66.0%) in misoprostol group and 15(40.5%) in Foley catheter group. Caesarean section was higher in Foley catheter group than misoprostol group (37.8% vs 18.9%). The mean birth weight, APGAR score 1 minute, 5 minute, admission in neonatal intensive care unit and meconium aspiration syndrome were not statistically significant between two groups (p&gt;0.05). Only one baby was died in Foley catheter group, but the difference was not statistically significant between two groups (p&gt;0.05). Conclusion: The present study suggests intravaginal Misoprostol results in a shorter induction to delivery time, a reduction in the rate of caesarean delivery. KYAMC Journal.2021;12(02): 78-83

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.

Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

High Frequency Oscillatory Ventilation Versus Conventional Ventilation in Management of Neonatal Meconium Aspiration syndrome

Meconium aspiration syndrome (MAS) is complex respiratory disease of the term and near-term neonate, which keeps on putting a significant weight on neonatal escalated care assets around the world. The point of this examination was appraisal of high recurrence oscillatory ventilation versus traditional ventilation in administration of neonatal meconium desire, Method: This imminent randomized controlled preliminary included 50 infants admitted to NICU with meconium yearning (MAS), were isolated into 2 gatherings: Group 1: 25 cases treated by customary mechanical ventilation (CMV), Group 2: 25 cases treated by high-recurrence oscillatory ventilator (HFOV). All included patients were exposed to full history taking, total clinical assessment, and research center appraisal. Changes in the oxygenation work markers was utilized for checking patients' reaction as: Fraction of motivation O2 (FiO2), Oxygenation list (OI), blood vessel oxygen pressure/alveolar blood vessel oxygen strain (a/ApO2), at 2, 12, 24, 48 h of treatment. Results: This investigation included 27 guys (54%) and 23 females (46%), the mean gestational age was 37.82±2.6 weeks, CMV gathering, had a measurably longer span of ventilation time (CMV: 7.24±0.65 days, HFOV: 4.23±1.37 days, p < 0.001), longer oxygen treatment (CMV: 15.39±2.44 days, HFOV: 11.76±5.32 days, p < 0.001), and longer season of hospitalization (CMV: 22.17±4.53 days, HFOV: 17.92±12.6 days, p < 0.001). End: Our outcomes demonstrated that HFOV seems to offer extra favorable circumstances contrasted with CMV in the treatment of MAS, by lessening the length of mechanical ventilation, and span of hospitalization, anyway it didn't influence the death rate.

Risk Factors and Perinatal Outcome of Meconium Stained Amniotic Fluid

Introduction: Meconium Stained Amniotic Fluid (MSAF) is a frequent finding during deliveries and is a cause for perinatal morbidity and mortality. Meconium Aspiration Syndrome (MAS) in neonates is an association in these deliveries with some infants requiring mechanical ventilation. This study was done with the aim of finding the risk factors for MSAF and its perinatal outcome. Methods: This was a hospital based, cross-sectional study. All the inborn babies delivered with MSAF were included in the study. Antenatal risk factors and perinatal outcomes like mode of delivery, Apgar score, NICU admission and neonatal morbidities mainly MAS were noted. Results: MSAF was seen in 202 (13.6%) neonates out of which 30 (15%)developed MAS. Antenatal risk factors were present in 97 (48%) cases. Mode of delivery was caesarean section in 78 (39%) and instrumental in 25 (13%) cases. Twenty three percent of the neonates required resuscitation at birth while 34% required respiratory support. Morbidities observed were meconium aspiration, pneumonia, septicaemia, perinatal asphyxia, shock, meconium gastritis and persistent pulmonary hypertension. Neonatal mortality amongst all neonates with meconium was 1.5%.Conclusion: Meconium stained amniotic fluid leading to aspiration is a significant cause of neonatal mortality and morbidity. Most of the risk factors for MAS are preventable.

Surfactant therapy for meconium aspiration syndrome in neonates: a systematic overview of systematic reviews and recent clinical trials

Aim: To conduct a systematic overview of systematic reviews(SRs) and randomized clinical trials (RCTs) on surfactant therapy in neonatal meconium aspiration syndrome. Methods: We searched EMBASE, PROQUEST and PubMed to summarize the different effects of surfactant lung lavage and bolus surfactant therapies in neonates with meconium aspiration syndrome. Results: With a total of 1377 patients, three SRs and two RCTs were included in analysis. Surfactant effectiveness was concluded by low-quality SRs, with high risk of bias, which was contradicted by high-quality SRs, with low risk of bias. In SRs, the surfactant lung lavage reduced mortality, need for extracorporeal membrane oxygenation and hospitalization, while the bolus surfactant did not. In recent high-quality RCTs, however, the two modalities did not significantly differ. Conclusion: The evidence on surfactant effectiveness and its method of administration is sparse and inconsistent.