Meconium Aspiration Syndrome: Have We Made a Difference?

Abstract

Meconium aspiration syndrome (MAS) and its associated complications are reviewed from the period before the routine use of intubation and suctioning to the present (1973 through 1987). Of the 176 790 neonates born during this period, the amniotic fluid was stained in 21 472 (12.15%). Subsequently, MAS developed in 1162 (5.41%) of the meconium-stained neonates. Male neonates were more prone to the disorder than female neonates (P = .022). There were no racial predilections for MAS. The incidence of MAS significantly decreased during the 15 years (P = .043). Of the neonates with MAS, 49 (4.22%) died as a direct consequence of the disorder. The death rate significantly declined during the study period (P = .041). Of the neonates with MAS, 345 (29.7%) required mechanical ventilation, and 134 (11.53%) had pneumothoraxes. Among neonates with MAS, the requirement for mechanical ventilation, as well as the incidence of pneumothoraxes, did not decrease from 1973 through 1987. The incidence of MAS has declined since the advent of combined obstetric and pediatric suctioning of the oropharynx and trachea. Furthermore, there are significantly fewer deaths from the disorder. These declines were likely influenced by other improvements in perinatal care, which have occurred since the early 1970s. The results do not support the contention that severe MAS and resultant deaths can be prevented altogether.

Fetal Heart Tracing Patterns and the Outcomes of Newborns With Meconium-Stained Amniotic Fluid

“…The rate of MSAF deliveries in our study was 3.8% compared to 7-22% from previously reported studies in term pregnancies [ 1 , 2 ]. This may be in part due to earlier inductions and deliveries and a low threshold for cesarean sections.…”

Meconium aspiration syndrome: Current concepts and management

“…One third of all infants with MAS require mechanical ventilation. 33 Fox and colleagues 34 as well as Truog et a135 found endotracheally applied continuous positive-end expiratory pressure /PEEP} to improve oxygenation in babies 3~ and lambs 35 with MAS. By contrast, some investigators 36 have found that air trapping and increased functional residual capacity (factors that increase the risk of air leaks) may be exacerbated by the application of PEEP.…”

Neonatal hypoxic risk in preterm birth infants: The influence of sex and severity of respiratory distress on cognitive recovery.

“…Additionally, boys tend to respond less favorably to therapeutic efforts intended to improve pulmonary function antenatally, with administration of steroids (Ballard et al, 1980; Papageorgiou, Colle, Farri-Kostopoulos, & Gelfand, 1981), or postnatally, with administration of surfactant (Arnold, Adams, Torres, & Sidebottom, 1996; Corchia et al, 1997). In comparison with their female counterparts, boys have higher rates of cerebral palsy (Sizun et al, 1998; Spinillo et al, 1997), as well as ante-, peri-, and postnatal complications (for an overview, see Raz et al, 1994), such as preeclampsia (Brothwood, Wolke, Gamsu, Benson, & Cooper, 1986), certain types of intrauterine growth retardation (Spinillo et al, 1994), prematurity (Khoury et al, 1985), abruptio placenta and placenta previa (James, 1995), neonatal infections (Fanaroff et al, 1998), anemia, apnea and hypocalcemia (Brothwood et al, 1986), hypoglycemia (Corchia et al, 1997), intracranial hemorrhage (Amato, Howald, & von Muralt, 1987; Shankaran, Bauer, Bain, Wright, & Zachary, 1996), and meconium aspiration (Wiswell, Tuggle, & Turner, 1990). Boys are also at greater risk for developing neonatal respiratory distress than are girls of the same gestational age (Brothwood et al, 1986; Catlin et al, 1990; Torday, Nielson, Fencl, & Avery, 1981), and their odds of developing chronic lung disorders during the neonatal period are increased (Korhonen, Tammela, Koivisto, Laippala, & Ikonen, 1999; Todd, Jana, & John, 1997).…”