DETRIMENTAL COMPLICATIONS OF MECONIUM ASPIRATION SYNDROME AND THEIR IMPACT ON OUTCOME
AbstractBackground: Meconium aspiration syndrome (MAS) is respiratory distress in an infant born through meconium stained amniotic fluid (MSAF) whose signs cannot be otherwise explained. MAS is associated with different complications. Many studies have been conducted in developed world to find the outcome associated with MAS but data from developing countries is lacking. Present study was conducted to determine the impact of chemical pneumonitis, pulmonary hypertension (PHN) and air leak on outcome of new-borns with MAS. Methods: This cross sectional descriptive study was conducted in a tertiary care Neonatology unit. The babies diagnosed with MAS were included in the study. All patients were monitored for development of complications. Outcome in terms of mortality was recorded. Outcome was compared by chi-square test and p-value <0.05 is considered significant. Results: Seventy two babies were included in the study. Mean gestation was 37±0.56 weeks and birth weight was 2.87±0.49 kg. Male to female ratio was 1.57:1 and mean age of admission was 9.59±5.27 hours. Chemical pneumonitis, PHN and chemical pneumonitis with PHN were observed in 23.6%, 20.8% and 26.4% neonates respectively. Mortality rate was 19.44%. The mortality was highest in babies having chemical pneumonitis with PHN (p-value=0.013) followed by chemical pneumonitis group (p-value=0.02) and PHN group (p-value=0.032). Conclusion: About three fourth babies with MAS developed one or more complications. Mortality is significantly increases with the development of complications so as more the complications more is the mortality.Keywords: Meconium Aspiration Syndrome; Chemical Pneumonitis; Persistent Pulmonary Hypertension.
Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008;28 (Suppl 3):S3–7.
Satomi M, Hiraizumi Y, Suzuki S. Perinatal outcomes associated with meconium-stained amniotic fluid in Japanese singleton pregnancies. Open J Obstet Gynecol 2011;1(2):42–6.
Yeh TF. Core Concepts: Meconium aspiration syndrome: pathogenesis and Current Management. NeoReviews 2010;11(9):e503–12.
Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. Int J Pediatr 2011;2012:359571.
Zea-Vear A, Ochoa TJ. Challenges in the diagnosis and management of neonatal sepsis. J Trop Pediatr 2015;61(1):1–13.
Nisar YB, Dibley MJ. Determinants of neonatal mortality in Pakistan: Secondary analysis of Pakistan demographic and health survey 2006-07. BMC Public Health 2014;14: 663.
Khan A, Kinney MV, Hazir T, Hafeez A, Wall SN, Ali N, et al. Newborn survival in Pakistan: a decade of change and future implications. Health Policy Plan 2012;27(3):iii72–87.
Masood MK, Sharif S, Butt NA. Meconium aspiration syndrome in meconium stained babies. Ann King Edw Med Univ 2011;17(4):429–32.
Anwar Z, Butt TK, Kazi MY. Mortality in meconium aspiration syndrome in hospitalized babies. J Coll Physicians Surg Pak 2011;21(11):695–9.
Emmerson AJ. Predictors of mortality in neonates with meconium aspiration syndrome. Indian Pediatr 2014;51(8):610–1.
Louis D, Sundaram V, Mukhopadhyay K, Dutta S, Kumar P. Predictors of mortality in neonates with meconium aspiration syndrome. Indian Pediatr 2014;51(8):637–40.
Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population- Base study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr 2012;2012:321545.
Kumar A, Bhatnagar V. Respiratory distress in neonates. Indian J Pediatr 2005;72(5):425–8.
Winnie GB, Lossef SV. Pneumothoax In: Kliegman R, Nelson WE, editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, PA: Elsevier/Saunders; 2011. p.1509–12.
Goldsmith JP. Continuous positive airway pressure and conventional mechanical ventilation in the treatment of meconium aspiration syndrome. J Perinatol 2008;28(Suppl 3):S49–55.
Dargaville PA, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factor, therapies, and outcome. Pediatrics 2006;117(5):1712–21.
Bonde JP, Wicox A. Ratio of boys to girls at Birth. BMJ 2007;334(7592):486–7.
Karabayir N, Demirel A, Bayramoglu E. Blood lactate level and meconium aspiration syndrome. Arch Gynecol Obstet 2015;291(4):849–53.
Zagariya A, Bhat R, Uhal B, Navale S, Freidine M, Vidyasagar D. Cell death and lung cell histology in meconium aspirated newborn rabbit lung. Eur J Pediatr 2000;159(11):819–26.
Espinheira MC, Grilo M, Rocha G, Guedes B, Guimaraes H. Meconium aspiration syndrome-the experience of a tertiary center. Rev Port Pneumol 2011;17(2):71–6.
Lee EC, Choi MG, Shim GH, Song YH, Chey MJ. Comorbid risk factors of persistent pulmonary hypertension of the newborn in infants with meconium aspiration syndrome. Neonatal Med 2014;21(3):166–71.
Choudhary M, Meena MK, Chhangani N, Sharm D, Choudhary JS, Choudhary SK. To study prevalence of persistent pulmonary hypertension in newborn with meconium aspiration syndrome in western Rajasthan, india: a prospective observational study. J Matern Fetal Neonatal Med 2016;29(2):324–7.
Lin HC, Su BH, Lin TW, Peng CT, Tsai CH. Risk factors of mortality in meconium aspiration syndrome: review of 314 cases. Acta Paediatr Taiwan 2004;45(1):30–4.
Velaphi S, Van Kwawegen A. Meconium aspiration syndrome requiring assisted ventilation:perspective in a setting with limited resources. J Perinatol 2008;28(Suppl 3):S36–42.