Changing Obstetric Practices Associated With Decreasing Incidence of Meconium Aspiration Syndrome

Yoder, Bradley A.; Kirsch, E; Barth, William H.; Gordon, Michael

doi:10.1097/00006250-200205000-00011

Cited by 56 publications

(75 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The effect of postmaturity and monitoring during pregnancy and labor on MAS is supported by reduction of MAS in institutions where postmaturity has been reduced and monitoring is intensive. 6 The protocol of intubating and suctioning infants suffering from absent or depressed respiration was not followed consistently, as only 53% of infants who should have been intubated according to the protocol were actually intubated. The possible reasons for this low rate of suctioning could be poor documentation of what happens during resuscitation, or that junior doctors who commonly conduct neonatal resuscitation in our hospital were not confident enough to perform intubations and therefore not adhering to protocol.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Recent literature has reported mortality rates less than 15%. 1,2,5 This reduction in mortality rates appears to be related (1) to reduction in incidence of MAS, which is related to changes in obstetric practices 6,7 and (2) to use of adjunct respiratory therapies, such as exogenous surfactant, nitric oxide and high-frequency ventilation in the management of neonates with MAS. [8][9][10] Yoder et al 6 reported that MAS decreased nearly fourfold between 1990 to1992 and 1997 to 1998, and this was associated with 33% reduction in births more than 41 weeks gestation, more frequent diagnosis of nonreassuring fetal heart rate patterns and greater use of amnioinfusion.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources

Velaphi

Kwawegen

2008

J Perinatol

View full text Add to dashboard Cite

To determine characteristics, management, complications and outcome of neonates with meconium aspiration syndrome (MAS) requiring mechanical ventilation (MV). A retrospective review of clinical data of neonates with MAS who were admitted to a public hospital for MV between January 2004 and December 2006. Eighty-eight neonates were ventilated for MAS. Thirtyone percent were postdates and 51% had no electronic fetal monitoring. Postnatal suctioning of meconium was not performed according to protocol in 47% of nonvigorous infants. High-frequency ventilation and surfactant were used in 32 and 14% of cases, respectively. Persistent pulmonary hypertension of the newborn (PPHN) and pneumothorax occurred in 57 and 24% of cases, respectively. Overall mortality rate was 33%. Neonates suffering from MAS with PPHN had higher mortality rate of 48% compared with 13% in those suffering from MAS without PPHN. Factors associated with mortality were peak inspiratory pressure (P<0.001), pneumothorax (P<0.001) and PPHN (P ¼ 0.001). Postdates, inadequate intrapartum monitoring and limited use of adjunct respiratory therapies were common. Severe MAS is associated with adverse outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources

Velaphi

Kwawegen

2008

J Perinatol

View full text Add to dashboard Cite

show abstract

“…Fetal pulse oximetry is a new modality for antepartum fetal surveillance [15][16][17] , but its effect on outcome remains ques tionable [18][19][20] . Amnioinfusion may be an effective therapy for pregnancies complicated by oligohydramnios and fetal distress.…”

Section: Prepartum Preventionmentioning

confidence: 99%

Meconium Aspiration Syndrome: The Core Concept of Pathophysiology during Resuscitation

Yeh

2017

Neonatal Med

View full text Add to dashboard Cite

Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulm onary hypertension, and surfactant inactivation all play a role in the pathogenesis of MAS. Most aspiration of meconium probably occurs before birth. Following aspira tion, meconium may migrate to the peripheral airway, usually take about 2 hours as demonstrated in animal experiment, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diag nosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the mana gement of MAS. Recent studies suggest that avoidance of post term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction at birth is considered a controversial procedure and only reserved for infants who have severe retraction at birth suggesting an upper air way obstruction. High fre quency oscillatory ventilation with nitric oxide or surfactant may improve mortality. Mortality of MAS has improved; the causes of death are relat ed primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.

show abstract

“…In contrast, several authors reported that intrapartum pharyngeal suctioning reduced the severity of MAS and the risk of respiratory distress. [61][62][63] They suggested that combined approach of intrapartum oropharyngeal suctioning and endotracheal suctioning was effective in the reduction of MAS.…”

Section: Pathophysiology and Risk Factorsmentioning

confidence: 99%

Obstetric approaches to the prevention of meconium aspiration syndrome

Wei

Fraser

2008

J Perinatol

View full text Add to dashboard Cite

Meconium aspiration syndrome (MAS) is associated with increased risk for perinatal mortality and morbidities. To provide an overview of the advances in our knowledge concerning the obstetric approaches to the prevention of MAS. The evidence of the effectiveness of intrapartum surveillance, amnioinfusion, and delivery room management in the prevention of MAS are reviewed in the present paper. Meconium aspiration syndrome remains one of the most common but challenging conditions for obstetricians and pediatricians. The available evidence did not demonstrate a beneficial effect of either of obstetric strategies in the prevention of MAS.

show abstract

Changing Obstetric Practices Associated With Decreasing Incidence of Meconium Aspiration Syndrome

Cited by 56 publications

References 25 publications

Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources

Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources

Meconium Aspiration Syndrome: The Core Concept of Pathophysiology during Resuscitation

Obstetric approaches to the prevention of meconium aspiration syndrome

Contact Info

Product

Resources

About