Assessment of incidence, determinants and co-morbidities associated with meconium aspiration syndrome: a hospital based study

Abstract

The most important consequence for a neonate born through meconium stained liquor (MSL) is meconium aspiration syndrome (MAS), and it occurs in 1-3% of live births. 1,2 The passage of meconium by the fetus occurs in 10%-15% of all live deliveries whereas the syndrome of meconium aspiration occurs in 10%-30% of all meconium stained infants and this approximates up to 1-3% of all live born infants. 3 This has been found to be a ABSTRACT Background: Meconium aspiration syndrome (MAS) was found to be major contributing factor towards perinatal morbidity and mortality. This condition is mainly accompanied with respiratory failure, pulmonary air leaks and pulmonary hypertension in neonates. A conservative approach of obstetrician-paediatrician combination moderates incidence of MAS and its complications. The objective of the study was to determine the incidence, determinants and co-morbidities associated with MAS in both intramural and out born admitted to the NICU and SNICU of a Chandulal Chandrakar memorial hospital located in Bhilai, Chattisgarh, India. Methods: This was a prospective study conducted in Chandulal Chandrakar memorial hospital, Bhilai from 1 st September 2013 to 31 st February 2015, in newborns with history of meconium stained amniotic fluid (MSAF) in both out-born and inborn units. Neonates who met inclusion criteria they were included in the study. The data were recorded in predesigned proforma. The data was analyzed using Chi square test. Level of significance of this data was set at p <0.05. Results: Incidence of MSAF in the inborn and out-born among all children admitted was 52.4% and 47.5% respectively. Out of total 202 subjects of MSAF, those with MAS were 29.7% and of these 75% were inborn and 25% were out-born. Male preponderance was high in the study compared to female babies. Incidence of MAS was significantly more in children of >2.5 kgs (80%) and common in primiparous mothers (60%) with lower segmental caesarian sections. MAS commonly seen in post-term babies (53.33%) than those of term (36.66%) or pre-term (10%) gestation. Fetal distress was the common complication observed in most of the cases (91.1%) and one death related to this was noted. At the end of 1 year there were predominantly more children (40%) who developed respiratory morbidities. Delayed development was seen among 13.3% children and transient tone abnormalities were noted in about 2% of infants. Conclusions: The overall incidence of MAS was found to have been 30% among cases of MSAF, which was relatively higher due to delayed referral. This percentage could have been reduced along with associated comorbidities with appropriate antenatal check-up's and timely referral.

Neonatal outcome in meconium stained amniotic fluid: a hospital based study

“…In a study by Afsar S et al, 57.5% and 42.5% were inborn males and females while 57.2% and 42.8% were outborn males and females comparable to our study. 17 David et al in their study reported that 48% were male and 52% female and was contradictory to the present study. 19 Eva Guachan et al in their study had M:F ratio of 1.8:1 which was in line with our study.…”

“…In study by Afsar S et al, incidence of MAS in inborn and outborn neonates was 15.6% and 42.5% respectively. 17 Similar observation was made by Malik AS et al (38% intramural and 68% extramural neonates). 18 In present study it was observed that of all intramural babies born with MSAF, 70.5%were males and 29.5% were females with M:F ratio of 2.4:1 with mortality in 4% and 7% of male and female neonates.…”

“…Similar findings were reported by Eva Guachan et al 20 Culture proven septicemia was seen in 21.6% cases; more in extramural than intramural cases and was similar to incidence reported by Afsar et al (35%), Anwar et al (27.5%) and Jeena S et al (21.3%). 12,17,28 Other complication observed, significantly associated with poor perinatal outcome were HIE, severe thrombocytopenia, NEC and ARF. Ashtekar S et al in their study concluded that Birth asphyxia (42%), Sepsis (23.2%), and Jaundice (23.2%) and others (7.8%) including IVH and NEC etc.…”

Maternal risk factors and meconium stained amniotic fluid

“…19 Afsar common among primiparous (60%) mothers than multiparous (40%) mothers with more mortality but the difference was not significant (p>0.05). 22 This was similar to the present study that MSAF was more common among primi gravid mothers. Sori et al reported that 66.8% mothers were primigravida in their study.…”

“…18 Similarly, Urvashi et al, Sankhyan et al, Narang et al, Sori et al and Afsar et al noted an increase in number of LSCS ranging from 45% to 71.66% in MSAF. 16,[19][20][21][22] Increase in incidence of LSCS in our study was seen which may be due to good foetal monitoring during delivery and resorting to LSCS at earliest sign of foetal distress. Moreover, our centre being a tertiary care centre, serves as a referral unit thus receiving more complicated cases from other centres of city and nearby PHC's and CHC's.…”