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

Abstract

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.

Retrospective review of neonates with persistent pulmonary hypertension of the newborn at Charlotte Maxeke Johannesburg Academic Hospital

“…Similar mortality rates, either directly or indirectly related to PPHN, were reported in previous studies across the world, e.g. : 48% at Chris Hani Baragwanath Academic Hospital [8] and 31% at Tygerberg Children's Hospital [7] in SA; 25% at Al-Minya University Hospital in Egypt; [6] 26.6% at the Children's Hospital Multan in Pakistan; [5] 32% at Hospital de São João EPE in Portugal; [9] and 27.6% at the Chang Gung Children's Hospital in Taiwan. [29] High PPHN mortality in resource-limited settings may be attributed to…”

“…[25] Despite remarkable progress in understanding the pathophysiology and treatment of PPHN, [10,[11][12][13][14] the condition remains a treatment challenge for neonatologists, especially in developing countries, and the associated mortality rate remains high in resource-limited settings. [5][6][7][8][9]26,27] Of the 72 neonates included in our study, 51.4% were female and 52.8% were born by vaginal delivery. Birth weight was appropriate for gestation age in 80.6% of cases in this study.…”

“…[5,6] In South Africa (SA), previous studies reported the incidence of PPHN to be 1.1%, with a mortality rate of 31% at Tygerberg Children's Hospital [7] and 48% at Chris Hani Baragwanath Academic Hospital. [8] PPHN develops due to the failure of circulatory transition at birth, causing the pulmonary artery pressure to remain higher than systemic pressures. [9] A patent ductus arteriosus (PDA) or the right-to-left shunting of blood through a patent foramen ovale (PFO) results in severe hypoxaemia.…”

Outcome of Neonates with Meconium Aspiration Syndrome at the University Hospital of the West Indies, Jamaica: A Resource-Limited Setting

“…There is presently a body of literature that suggests there is no need for routine intubation and suctioning of neonates with MAS. 3,7,11,12 In our study, retrieval of meconium from beneath the vocal cords was an independent predictor of severe meconium aspiration. This would suggest that although meconium was retrieved from beneath the cords, aspiration had already occurred and therefore suctioning did not have an impact on preventing aspiration or disease severity.…”

“…This is in keeping with findings by Velaphi and Van Kwawegen in South Africa who found that 44% of the mothers in their study were delivered operatively and in most cases (90%) it was due to fetal distress. 7 Dargaville and Copnell in Australia and New Zealand also documented a similar rate of operative delivery (42%). 4 It has been documented that advanced gestational age increases the risk of MAS.…”