Outcome of Neonates with Meconium Aspiration Syndrome at the University Hospital of the West Indies, Jamaica: A Resource-Limited Setting

Abstract

Aim To determine the outcome of neonates with meconium aspiration syndrome (MAS) at the University Hospital of the West Indies over a 5-year period.

Methods This was a retrospective, descriptive study looking at all inborn neonates with MAS. Data on maternal and neonatal demographics, clinical course, and outcome were recorded. Descriptive analyses were performed.

Results The incidence of MAS was 10 per 1,000 live births. Fetal distress was documented in 32 (30%) cases. Thirty-two (30%) neonates were postdates at the time of delivery and 32 (30%) neonates were delivered by emergency cesarean section. Seven (6%) neonates required mechanical ventilation and 16 (15%) required bubble continuous positive airway pressure. Seven (6%) neonates had hypoxic ischemic encephalopathy, 5(5%) had persistent pulmonary hypertension of the newborn, and 1 (4%) had a pneumothorax. There was a 1% mortality rate. Thick meconium beneath the cords, grunting, and hypoxia on admission were independent predictors of disease severity.

Conclusion The incidence of MAS was similar to that of other resource-limited settings; however, the disease spectrum was milder with lower morbidity and mortality.

Keywords

meconium aspiration syndrome - meconium - outcome in MAS - predictors of MAS

• References

• 1 Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998; 45 (03) 511-529
• 2 Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome. Unresolved issues. Pediatr Clin North Am 1993; 40 (05) 955-981
• 3 Fuloria M, Wiswell TE. Resuscitation of the meconium-stained infant and prevention of meconium aspiration syndrome. J Perinatol 1999; 19 (03) 234-241
• 4 Dargaville PA, Copnell B. ; Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006; 117 (05) 1712-1721
• 5 Yeh TF. Core concepts: meconium aspiration syndrome: pathogenesis and current management. Neoreviews 2010; 11 (09) e503-e512
• 6 Vivian-Taylor J, Sheng J, Hadfield RM, Morris JM, Bowen JR, Roberts CL. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. BJOG 2011; 118 (13) 1601-1607
• 7 Velaphi S, Van Kwawegen A. Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources. J Perinatol 2008; 28 (Suppl. 03) S36-S42
• 8 Singh BS, Clark RH, Powers RJ, Spitzer AR. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol 2009; 29 (07) 497-503
• 9 Basu S, Kumar A, Bhatia BD. Role of antibiotics in meconium aspiration syndrome. Ann Trop Paediatr 2007; 27 (02) 107-113
• 10 Fischer C, Rybakowski C, Ferdynus C. , et al. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr 2012; 2012: 321545 . Doi: 10.1155/2012/321545
• 11 Chettri S, Adhisivam B, Bhat BV. Endotracheal suction for nonvigorous neonates born through meconium stained amniotic fluid: a randomized controlled trial. J Pediatr 2015; 166 (05) 1208-1213.e1
• 12 Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term. Cochrane Database Syst Rev 2001; (01) CD000500 . Doi. 10.1002/14651858.CD000500
• 13 Paz Y, Solt I, Zimmer EZ. Variables associated with meconium aspiration syndrome in labors with thick meconium. Eur J Obstet Gynecol Reprod Biol 2001; 94 (01) 27-30
• 14 Liu WF, Harrington T. Delivery room risk factors for meconium aspiration syndrome. Am J Perinatol 2002; 19 (07) 367-378
• 15 Lin HC, Su BH, Tsai CH, Lin TW, Yeh TF. Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection. Biol Neonate 2005; 87 (01) 51-55
• 16 Espinheira MC, Grilo M, Rocha G, Guedes B, Guimarães H. Meconium aspiration syndrome - the experience of a tertiary center. Rev Port Pneumol 2011; 17 (02) 71-76