Infection and amniotic aspiration of middle ear in stillbirths and neonatal deaths.

Abstract

Aspirated debris in the middle ear was seen commonly in infants of over 28 weeks' gestation who bad suffered from intrapartum asphyxia, and was usually associated with evidence of pulmonary aspiration of amniotic squames. Most of these infants were stillborn or had died in the first 2 days of postnatal life, but amniotic debris persisted for a longer period in some, and in 8 cases it had excited a foreign body histiocyte reaction.The 17 cases with otitis media could be divided into two groups on the basis of middle ear findings: 11 cases with an admixture of amniotic debris and purulent exudate (P/A group) and 6 with purulent exudate only. The P/A group showed many clinical features in common with the infants of the aspiration group, with a high incidence of pregnancy complications and of need for prolonged ventilation.All 17 cases with otitis media had evidence of infection elsewhere, including pneumonia (12) and meningitis (6). In 13 of the 14 cases with positive bacteriology, the organisms cultured were Gram-negative (Esch. coli or Pseudomonas aeruginosa).It is argued that amniotic debris may be aspirated into the middle ear in asphyxiated babies and this may explain some of the unusual metaplastic changes noted in the epithelium of the middle ear cavities. Furthermore, stagnant amniotic debris may become secondarily infected by organisms, particularly if the infant requires ventilation.While infections of the middle ear are known to be common in older children, relatively little attention has been paid to similar infections occurring in newborn infants. This is surprising since it has been shown by many writers that middle ear infections are common in this age group (Benner, 1940;Allen, Morison, and Rutherford, 1946;McLellan et al., 1962 The left middle ear cavity was examined using the procedure described by Morison (1970). Smears of any fluid or exudate present were taken, and whenever purulent exudate was present bacteriological samples were taken for culture. The petrous temporal bone on the right side was dissected away from the skull so as to include the terminal portion of the extemal auditory canal and the tympanic membrane in continuity with the 872 on 11 May 2018 by guest. Protected by copyright.

The Neonate Has a Temporary Conductive Hearing Loss due to Fluid in the Middle Ear

“…In addition the middleear (ME) cavity, which is full of amniotic fluid during pregnancy [de Sa, 1972;Eavey, 1993], is postnatally cleared of this fluid and becomes gas filled. Therefore it is likely that during the immediate postnatal period, a conductive hearing loss may be present due to this amniotic fluid, followed by an improvement in hearing as this fluid is cleared.…”

Meconium contaminated amniotic fluid and infant otitis media

“…Aschoff's findings were later confirmed by DeSa [2] in temporal bones from 130 stillbirths and neonates, 55 of which showed collection of amniotic debris in the middle ear compartments, usually associated with pulmonary aspiration of AFCC. If the neonates lived longer, up to 27 days, foreign body giant cells and histiocytes were seen engulfing the debris.…”

Wideband absorbance measures in neonates and young infants

“…Temporal bone studies have demonstrated that the condition of the middle ear in neonates is seldom pristine (Benner, 1940;Buch & Jorgensen, 1964;deSa, 1973deSa, , 1983Hemsath, 1936) with MEE present in up to 50% of ears (deSa, 1973;Eavey, 1993). The middle ear and antrum of a neonate have been reported to contain some amniotic fluid or residual mesenchyme and its cellular content.…”

“…Amniotic fluid contents aspirated into the middle ear have often been reported to contribute to MEE and conductive hearing loss in newborns (deSa, 1973;Northrop, Piza, Karmody, & Eavey, 1999;. The volume of aspirated amniotic fluid has been reported to vary markedly from a very scant amount to a sizeable inoculum that fills up a substantial portion of the middle ear and antral space (Northrop, Piza, & Eavey, 1986;Piza et al, 1989).…”

“…The volume of aspirated amniotic fluid has been reported to vary markedly from a very scant amount to a sizeable inoculum that fills up a substantial portion of the middle ear and antral space (Northrop, Piza, & Eavey, 1986;Piza et al, 1989). The aspirated amniotic debris, instead of being cleared rapidly from the airways and the middle ears, may persist for several days (deSa, 1973). Histologic observations have shown that this material induces a significant inflammatory response of a foreign body giant cell reaction that produces a large volume of granulation tissue as well as advanced inflammatory responses resulting in extensive damage to the major attic compartments and underpneumatisation of the mastoid (deSa, 1973;Eavey, Camacho, & Northrop, 1992;Piza et al, 1989;).…”