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

Panton, Lindsey J.; Trotman, H

doi:10.1055/s-0037-1603330

Cited by 5 publications

(6 citation statements)

References 17 publications

(23 reference statements)

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“…PPHN is a leading cause of death in neonates with sMAS (42). In the current study, more than half of the cohort developed PPHN, lower than in the previous South African study (57%) (11) but significantly higher than a Jamaican (5%) (10) and Indian study (17%) (8).…”

Section: Persistent Pulmonary Hypertension (Pphn)contrasting

confidence: 85%

“…These include hypoxic respiratory failure, PPHN, air leak syndromes and asphyxia. Although these are reported as low in high resource countries (1,5,6), their incidence remains high or unknown in low resource countries (10,11). The clinical and complications of MAS differs between developing and developed countries and affects management techniques (12).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

Busgeeth,

Goussard,

Van Wyk

2024

Pediatr Respir J

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Meconium aspiration syndrome (MAS) is defined as respiratory distress in a neonate born through meconium-stained liquor (MSAL) whose symptoms cannot be otherwise explained. Mortality and morbidities vary in different resourced health settings. This retrospective study aimed to describe the management strategies, short-term (in-hospital) outcomes and mortality of neonates with severe MAS (defined as those requiring invasive ventilation) at a resource restricted hospital in Cape Town, South Africa.Ninety-two neonates with suspected MAS were included, of which only 47 were included based on the radiological findings (patchy infiltrates and hyperinflation).The mean gestational age was 39.7 ± 1.4 weeks and mean birth weight was 3246 ± 522g. Most neonates were outborn. High frequency ventilation was the most common initial mode of ventilation (55%). The median duration of invasive ventilation was 3 (IQR 2-4.5) days and total duration of respiratory support was 9 (IQR 4-16) days. Surfactant was administered in 70% of neonates. Pulmonary hypertension (PPHN) developed in 53% and 88% received inhaled nitric oxide.Inotropes were administered to 45% of neonates and steroids were administered in 64%. Pneumothorax was present in 9%. Neonates were discharged from NICU after a median age of 5 (IQR 3-7) days and had a hospital stay of 12 (IQR 6-21) days. Overall mortality was 8.5% (n = 4).Mortality was low and complications (PPHN and sepsis) were high, remaining higher than in high resource countries. Management of PPHN and hypotension, as well as steroid administration were variable. A protocolized management strategy should be adopted, according to resource availability. HIGHLIGHTS BOXWhat is already known about this topic? Meconium aspiration syndrome is associated with a variety of complications. Management is varied, mostly supportive and differs depending on health care resources. What does this article add to our knowledge? With a combination of therapies, morbidities remain high but mortality decreases, in a resource restricted institution but remains higher than in high resource institutions. How does this study impact current management guidelines? Therapies -high frequency ventilation, surfactant, inotropes and inhaled nitric oxide -should be combined to improve outcomes, especially in resource restricted institutions.

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Section: Persistent Pulmonary Hypertension (Pphn)contrasting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

Busgeeth,

Goussard,

Van Wyk

2024

Pediatr Respir J

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“…Our results show a lower incidence of MAS than what has been reported from other developing countries (9 -10 per 1 000 live births). [7,8] Almost two-thirds of MAS cases in our study were male (63.6%), but this was not statistically significantly associated with disease severity. Similar results were found in other studies, as, for example, in a study by Dargaville et al, [4] who found 52.4% of MAS cases being male and 42% born by caesarean section.…”

Section: Discussioncontrasting

confidence: 57%

“…In developed countries, incidence of MAS ranges between 0.4 and 1 per 1 000 deliveries, [4][5][6] whereas the incidence is approximately 10 times higher (4 -11 per 1 000 births) in developing countries. [2,7,8] The overall incidence of MAS and severe MAS increases with increasing gestational age. [4,6] Fischer et al [6] found MAS incidences of 11% (i.e.…”

Section: Researchmentioning

confidence: 99%

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Singh

Adhikiri²,

Tinarwo³

et al. 2022

S Afr J Child Health

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Background. Meconium aspiration syndrome (MAS) occurs in approximately 5% of babies born through meconium-stained amniotic fluid. Risk factors associated with severity of MAS in neonates from developing countries has been infrequently described. Objective. To identify incidence and risk factors associated with the severity of MAS in a lower middle-income country. Method. A retrospective descriptive analysis was conducted on records of neonates diagnosed with MAS at four regional hospitals in the eThekwini district of KwaZulu-Natal, South Africa, between 1 January 2015 and 31 December 2017. Results. A total of 187 neonates had been diagnosed with MAS, of whom 157 survived. The overall incidence of MAS was 2 per 1 000 live births. All the neonates were born through thick meconium. The majority (n=119, 63.6%) of patients were male. Asphyxia was documented in 97 cases (51.9%) and was significantly associated with severe disease (p<0.001). Seizures were noted in 91patients (48.7%), of which 86 (94.5%) occurred in neonates with asphyxia. A quarter of the sample (n=47, 25%) were outborn, with severe disease associated significantly with this group (p=0.025). Multiple logistic regression showed that the occurrence of seizures was significantly associated with severe MAS, (adjusted odds ratio = 23.7, 95% confidence interval 7.58 - 97.7; p<0.001). Conclusion. Neonates born through thick meconium, with moderate to severe asphyxia that is associated with seizures are at increased risk of developing severe MAS. Close monitoring of labour in the intrapartum period, early recognition of fetal distress and timely obstetric intervention are crucial to prevent asphyxia.

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“…1 It is associated with significant mortality 2 and morbidities including persistent pulmonary hypertension and pneumonitis 3,4 particularly in developing countries. [5][6][7] It is crucial to identify infants at high risk of acquiring MAS and to distinguish cases with severe disease. This constitutes the cornerstone of effective prevention and treatment strategy in low-resource setting.…”

Section: Introductionmentioning

confidence: 99%

Value of Neutrophil to Lymphocyte Ratio in Early Prediction of Meconium Aspiration Syndrome

Gad

Alkhalafawi²,

Raza

et al. 2020

Journal of Child Science

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Meconium aspiration syndrome (MAS) is a serious neonatal condition. Prediction of MAS is challenging particularly in low-resource setting. Neutrophil to lymphocyte ratio (NLR) is a new simple index used for diagnosis of many inflammatory conditions. The present study was an attempt to determine whether NLR can predict the occurrence of MAS. The present study included 101 children with meconium-stained amniotic fluid. They comprised 22 patients who developed MAS and 79 neonates who didn't have the condition. All neonates were subjected to careful analysis of maternal and perinatal history in addition to thorough clinical assessment and radiological and laboratory evaluation. Blood samples from the umbilical cord were collected at birth and were used to obtain complete blood counts and C-reactive protein (CRP) assay. Univariate analysis revealed that elevated CRP levels, increased NLR, and 5-minute Apgar score of <7 were significant risk factors for the occurrence of MAS. Multivariate analysis revealed that low 5-minute Apgar score and increased NLR remained as significant risk factors of MAS. Receiver operating characteristic curve analysis showed good performance of NLR in prediction of MAS. NLR is useful in prediction of MAS in term neonates with meconium-stained amniotic fluid.

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

Cited by 5 publications

References 17 publications

Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

Epidemiology and risk factors for acquiring and predicting disease severity in meconium aspiration syndrome

Value of Neutrophil to Lymphocyte Ratio in Early Prediction of Meconium Aspiration Syndrome

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