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

Abstract

Objective: The purpose of this study was to evaluate the demographic and treatment characteristics of neonates (X37 weeks' estimated gestational age) who were admitted to a neonatal intensive care unit (NICU) for a diagnosis of meconium aspiration syndrome (MAS) during the years 1997 to 2007. The goals in studying this group of neonates were to better estimate the magnitude of abnormal outcomes and to determine the proportion of these infants exposed to specific therapeutic interventions.Study Design: Retrospective review of an administrative de-identified data set.Result: A total of 415 772 neonates formed the starting data set and 162 075 (39%) were X37 weeks. Of the 162 075 term neonates, 7518 (1.8% of all neonates and 4.6% of term NICU admissions) had an admission diagnosis of MAS. In the 7518 neonates, the following outcomes were observed: 6124 (81.5%) were discharged home; 679 (9%) were acutely transferred to a higher level of intensive care; 416 (5.5%) were transferred to another clinical service within the hospital; 178 (2.4%) were transferred to another NICU for convalescent care and 88 (1.2%) died. There were 33 (0.4%) who did not have data on outcome at discharge. During the period between 2002 and 2005, acute transfer rates decreased (12.4 to 9%) and the reported rate for death remained relatively constant between 0.9 and 1.5%. There were 107 (1.4%) neonates who were treated (n ¼ 61) with, or transferred, for extracorporeal membrane oxygenation (ECMO) (n ¼ 46). Three of the sixty-one neonates (4.9%) who were treated with ECMO died. Conclusion:Term neonates who are admitted with a diagnosis of MAS continue to represent a high-risk population with significant morbidity, and they often require intensive therapies.

Meconium aspiration syndrome: challenges and solutions

“…In the same study, APGAR score <3, the need for ventilator support within 48 hours, the repeated dose of vasopressor agents, and the use of cefotaxime were found to be independent risk factors for mortality. 80 In a recent trial from India, mortality rate was found to be as high as 26%, with lower birth weight, the presence of myocardial dysfunction, and higher initial oxygen requirement being independent predictors of mortality. 81 Approximately, one third of these deaths in MAS are directly attributable to pulmonary cause, with the remainder being ascribed to accompanying hypoxic ischemic encephalopathy.…”

“…8 Others like oxygen supplementation at 28 days (5%), seizures (4%), or pulmonary hemorrhage occur in only in a small proportion of infants. 8,80 Long-term pulmonary morbidity, especially in the form of reactive airway disease, is common, with about half of babies developing episodes of coughing/wheezing during infancy. 82 Older children are likely to have mild airway obstruction, hyperinflation, and airway hyper-responsiveness with normal pulmonary function test and chest X-ray.…”

Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk

“…Data are also configured into tables that can be joined and queried for statistical analyses. Using the de-identified data set, from which several other observations have been reported, [11][12][13] we performed a retrospective case series review of neonates with a diagnosis of renal problems. Cases were identified by searching the diagnosis table in our database for the terms 'renal failure and/or dysfunction.'…”

Audit of Neonatal Morbidity and Mortality in A Tertiary Care Hospital, Sylhet

“…Apparently, it seems that RDS & MAS are the leading causes of neonatal mortality in this study which does not reflect the true pictures, because the numbers of admitted cases in these two subgroups were very small resulted high mortality mathematically. A large retrospective analysis demonstrated the overall mortality rate for MAS to be 1.2% in the US, but the mortality may be as high as 20% in severe disease 15 . Another study showed that antenatal corticosteroid therapy to women at risk of preterm delivery reduces the incidence of RDS morbidity and mortality 16 .…”