Exposure to Meconium-Stained Amniotic Fluid and Long-Term Neurological-Related Hospitalizations throughout Childhood

Ron Matalon; Tamar Wainstock; Asnat Walfisch; Eyal Sheiner

doi:10.1055/s-0040-1713863

American Journal of Perinatology, Table of Contents

Am J Perinatol 2021; 38(14): 1513-1518
DOI: 10.1055/s-0040-1713863

Original Article

Exposure to Meconium-Stained Amniotic Fluid and Long-Term Neurological-Related Hospitalizations throughout Childhood

Authors

Ron Matalon

¹Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Ben Gurion University of the Negev, Beer-Sheva, Israel

²Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Tamar Wainstock

³Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
Asnat Walfisch

⁴Department of Obstetrics and Gynecology, Hadassah Mt. Scopus Medical Center, Jerusalem, Israel
Eyal Sheiner

²Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Abstract

Objective This study aimed to investigate the possible impact of meconium-stained amniotic fluid (MSAF) on the occurrence of neurological-related hospitalizations throughout childhood and adolescence.

Study Design In this population-based cohort analysis, all singleton deliveries occurring between 1991 and 2014 at the Soroka University Medical center were included and the long-term neurological-related hospitalizations were compared between children with and without MSAF during their delivery. A Kaplan-Meier survival analysis was constructed for the evaluation of cumulative hospitalization rate due to neurological morbidity over the 18 years of follow-up, and a Cox proportional hazards model was used to study the independent association between MSAF and childhood neurological morbidity while controlling for potential confounders.

Results During the study period, 243,725 deliveries met the inclusion criteria; 35,897 of the cohort (15%) constituted the exposed group (MSAF), while the rest of the cohort (n = 207,828) constituted the unexposed group (no MSAF). A total of 7,543 hospitalizations due to neurological-related morbidity were documented with a rate of 3.2% (1,152) in children exposed to MSAF as compared with 3.1% (6,391) in the unexposed group (OR 1.1, 95% confidence interval 0.9–1.1, p = 0.149). The survival curve showed a comparable cumulative hospitalization rate in the MSAF-exposed group compared with the unexposed group (log rank p = 0.349). The Cox analysis, controlled for gestational diabetes and hypertension, gestational and maternal ages, demonstrated MSAF exposure not to be an independent risk factor for neurological-related hospitalizations during childhood (adjusted hazard ratio = 1.03, 0.96–1.09).

Conclusion Fetal exposure to MSAF, at any gestational age, does not appear to be an independent risk factor for later neurological-related hospitalizations throughout childhood and adolescence.

Key Points

MSAF is associated with several short-term complications such as low Apgar scores.
The long-term implications of MSAF exposure are yet to be clearly defined.
Fetal exposure to MSAF is not a risk factor for neurological morbidity throughout childhood.

Keywords

meconium-stained amniotic fluid - long-term outcome - neurological morbidity

Full Text

References

References
1 Romero R, Yoon BH, Chaemsaithong P. et al. Bacteria and endotoxin in meconium-stained amniotic fluid at term: could intra-amniotic infection cause meconium passage?. J Matern Fetal Neonatal Med 2014; 27 (08) 775-788
2 Hansen R, Scott KP, Khan S. et al. First-pass meconium samples from healthy term vaginally-delivered neonates: an analysis of the microbiota. PLoS One 2015; 10 (07) e0133320
3 Tapiainen T, Paalanne N, Tejesvi MV. et al. Maternal influence on the fetal microbiome in a population-based study of the first-pass meconium. Pediatr Res 2018; 84 (03) 371-379
4 Maoz O, Wainstock T, Sheiner E, Walfisch A. Immediate perinatal outcomes of postterm deliveries. J Matern Fetal Neonatal Med 2019; 32 (11) 1847-1852
5 Lee KA, Mi Lee S, Jin Yang H. et al. The frequency of meconium-stained amniotic fluid increases as a function of the duration of labor. J Matern Fetal Neonatal Med 2011; 24 (07) 880-885
6 Pariente G, Peles C, Perri ZH. et al. Meconium-stained amniotic fluid—risk factors and immediate perinatal outcomes among SGA infants. J Matern Fetal Neonatal Med 2015; 28 (09) 1064-1067
7 Hiersch L, Krispin E, Aviram A, Wiznitzer A, Yogev Y, Ashwal E. Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term. Am J Perinatol 2016; 33 (04) 378-384
8 Ohana O, Holcberg G, Sergienko R, Sheiner E. Risk factors for intrauterine fetal death (1988-2009). J Matern Fetal Neonatal Med 2011; 24 (09) 1079-1083
9 Brailovschi Y, Sheiner E, Wiznitzer A, Shahaf P, Levy A. Risk factors for intrapartum fetal death and trends over the years. Arch Gynecol Obstet 2012; 285 (02) 323-329
10 Sheiner E, Hadar A, Shoham-Vardi I, Hallak M, Katz M, Mazor M. The effect of meconium on perinatal outcome: a prospective analysis. J Matern Fetal Neonatal Med 2002; 11 (01) 54-59
11 Swaminathan S, Quinn J, Stabile MW, Bader D, Platzker AC, Keens TG. Long-term pulmonary sequelae of meconium aspiration syndrome. J Pediatr 1989; 114 (03) 356-361
12 Paz Levy D, Walfisch A, Wainstock T. et al. Meconium-stained amniotic fluid exposure is associated with a lower incidence of offspring long-term infectious morbidity. Am J Reprod Immunol 2019; 81 (06) e13108
13 Krieger Y, Horev A, Wainstock T, Sheiner E, Walfisch A. Meconium stained amniotic fluid as a protective factor against childhood dermatitis and skin rash related hospitalization in the offspring—a population based cohort analysis. J Eur Acad Dermatol Venereol 2019
14 Central Bureau of Statistics. Localities in Israel, 2008–2017. Accessed February 6, 2019 at: https://www.cbs.gov.il/he/mediarelease/DocLib/2019/042/01_19_042b.pdf
15 Gur Z, Tsumi E, Wainstock T, Walter E, Sheiner E. Association between delivery of small-for-gestational age neonate and long-term pediatric ophthalmic morbidity. Arch Gynecol Obstet 2018; 298 (06) 1095-1099
16 Poggi SH, Ghidini A. Pathophysiology of meconium passage into the amniotic fluid. Early Hum Dev 2009; 85 (10) 607-610
17 Bensal A, Weintraub AY, Levy A, Holcberg G, Sheiner E. The significance of peripartum fever in women undergoing vaginal deliveries. Am J Perinatol 2008; 25 (09) 567-572
18 Beligere N, Rao R. Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol 2008; 28 (Suppl. 03) S93-S101
19 Chettri S, Bhat BV, Adhisivam B. Current concepts in the management of meconium aspiration syndrome. Indian J Pediatr 2016; 83 (10) 1125-1130
20 Bandyopadhyay T, Bhatia BD, Khanna HD. A study of oxidative stress in neonates delivered through meconium-stained amniotic fluid. Eur J Pediatr 2017; 176 (03) 317-325
21 Prasanth K, Kamat M, Khilfeh M, Davis V. Adrenocorticotropic hormone and cortisol levels in term infants born with meconium-stained amniotic fluid. J Perinat Med 2014; 42 (06) 699-703
22 Li T, Koshy S, Folkesson HG. IL-1beta-induced cortisol stimulates lung fluid absorption in fetal guinea pigs via SGK-mediated Nedd4-2 inhibition. Am J Physiol Lung Cell Mol Physiol 2009; 296 (03) L527-L533
23 Lamontagne F, Brower R, Meade M. Corticosteroid therapy in acute respiratory distress syndrome. CMAJ 2013; 185 (03) 216-221
24 Jantz MA, Sahn SA. Corticosteroids in acute respiratory failure. Am J Respir Crit Care Med 1999; 160 (04) 1079-1100
25 Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: a systematic review and meta-analysis. Obstet Gynecol 2015; 125 (06) 1385-1396
26 Baumfeld Y, Sheiner E, Wainstock T. et al. Elective cesarean delivery at term and the long-term risk for neurological morbidity of the offspring. Am J Perinatol 2018; 35 (11) 1038-1043
27 Shreiner AB, Kao JY, Young VB. The gut microbiome in health and in disease. Curr Opin Gastroenterol 2015; 31 (01) 69-75
28 West CE. Gut microbiota and allergic disease: new findings. Curr Opin Clin Nutr Metab Care 2014; 17 (03) 261-266
29 Black M, Bhattacharya S, Philip S, Norman JE, McLernon DJ. Planned cesarean delivery at term and adverse outcomes in childhood health. JAMA 2015; 314 (21) 2271-2279
30 Adlercreutz EH, Wingren CJ, Vincente RP, Merlo J, Agardh D. Perinatal risk factors increase the risk of being affected by both type 1 diabetes and coeliac disease. Acta Paediatr 2015; 104 (02) 178-184
31 Moshkovsky R, Wainstock T, Sheiner E, Landau D, Walfisch A. Elective cesarean delivery at term and the long-term risk for endocrine and metabolic morbidity of the offspring. J Dev Orig Health Dis 2018; 27: 1-7
32 Hiersch L, Melamed N, Rosen H, Peled Y, Wiznitzer A, Yogev Y. New onset of meconium during labor versus primary meconium-stained amniotic fluid—is there a difference in pregnancy outcome?. J Matern Fetal Neonatal Med 2014; 27 (13) 1361-1367
33 Gluck O, Kovo M, Tairy D, Herman HG, Bar J, Weiner E. The effect of meconium thickness level on neonatal outcome. Early Hum Dev 2020; 142: 104953
34 Rodríguez Fernández V, López Ramón Y Cajal CN, Marín Ortiz E, Couceiro Naveira E. Intrapartum and perinatal results associated with different degrees of staining of meconium stained amniotic fluid. Eur J Obstet Gynecol Reprod Biol 2018; 228: 65-70