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MECONIUM ASPIRATION SYNDROME: AN EXPERIENCE IN NEONATOLOGY DEPARTMENT OF CHILDREN HOSPITAL LAHORE.

Byline: Imran Khan and Haji Gul

ABSTRACT

Objectives: To determine the frequency of complications like air leak syndrome and persistent pulmonary hypertension (PPHN) in neonates with meconium aspiration syndrome in Children Hospital Lahore.

Methods: A descriptive cross sectional study was conducted in Neonatology Department of Children Hospital, Lahore from 10th august 2013 to 10th February 2014. All patients having meconium aspiration syndrome (MAS) who survived with age 60/min) and cyanosis (S P O 2 <87%). PPHN was diagnosed as patient with MAS and loud 2nd heart sound supported by echocardiography. Similarly air leak syndrome was diagnosed if a neonate with MAS having decreased air entry on one or both sides of chest and supported by x-ray chest having lung collapse and tracheal daviation. All the patients having MAS who survived and <28 days of age and patients of either sex were included in the study. All those patients having meconium aspiration syndrome who could not survived and age above 28 days were excluded from the study.

A total of 150 patients were enrolled in the study with 95% confidence level' 5% margin of error and taking expected percentage of airleak syndrome as 9.6% during this period fulfilling the inclusion and exclusion criteria.

Patients fulfilling the inclusion criteria were enrolled in the study. After taking informed consent from parents, the neonates were examined for meconium staining, tachypnea and cyanosis. Chest X-Ray and echocardiography were performed to look for complications of MAS. Oxygen saturation were checked by oxygen saturation probes and arterial blood gases. All this information was recorded on a pre designed proforma. The data was entered into computer and analyzed using statistical package for social sciences (SPSS) 18. The data was described in terms of mean SD (standard deviation) for quantitative variables like age. Frequencies and percentages were given for qualitative variables like air leak syndrome and pulmonary hypertension. Graphs were presented for both qualitative and quantitative variables.

RESULTS

Out of 150 patients, there were 102(68%) male patients and 48(32%) patients were females. A total of 118 (78.6%) babies were discharged and 32 babies (21.4%) expired. 88 patients (58.6%) were born at term and 62 patients (41.3%) were post term.

Caesarean section was the most frequent mode of delivery in patients with MAS (56%). Other modes are shown in Figure 1.

Persistent pulmonary hypertension (PPHN) developed in 63 (42%) babies. Complications in patients with MAS are shown in Figure 2.

DISCUSSION

Despite so much obstetrical and neonatal care , MAS continues to be neonatal respiratory disorder with high morbidity and mortality in Pakistan. Meconium aspiration syndrome (MAS) is a problem found all over the world, irrespective of race and ethnicity. MAS is a major issue regarding respiratory morbidity in neonatal intensive care units (NICU) everywhere in the world but has been efficiently dealt, with proper antenatal obstetrical care and better facilities available for post-natal management of newborns like extracorporeal membrane oxygenation (ECMO). In Pakistan, it has been a leading cause of admissions in NICU, found to be the 5 th in list in a study done by Parkash et al 10 in Karachi after infections, asphyxia, jaundice and prematurity. In Pakistan, health facilities are still not enough and limited only to developed cities so there is substantial morbidity and mortality caused by this condition.

In this study, the objective was to assess the spectrum of complications, which arise in newborns admitted with MAS particularly PPHN and pneumothorax. Most common complication observed was persistent pulmonary hypertension of newborn (PPHN) 42% in babies admitted. According to study by Razzaql7 in Multan Children Complex , the frequency of PPHN was 35.5 % where as another study by Dargaville et al11 showed that the frequency of PPHN is 47.5%.

Pneumothorax was found to be the 2nd most arisen complication, seen in 14.6% of babies, which is close to a study done by Razzaq7, where it was 13.3%. However in a study done by Greenbough et al9, it was shown to be 15-33% in infants with MAS. Our study differs from this international study, perhaps due to less use of mechanical ventilation, as this is an important risk factor for development of pneumothorax, and our unit does not have enough ventilatory support for these babies.

Mortality was found to be 21.4% in this study; it was very high as compared to 5% mortality shown by Velaphi et al8 in their study, and 20% by Razzaq7. Again it might be due to insufficient facilities for managing these babies, and also due to a large burden of neonates which our nursery is receiving apart from MAS.

This study also highlighted some other important variables like risk factors for MAS. The most common was postmaturity (41.3%) which was similar to other studies which show an increase incidence of MAS after 40 weeks of gestation1. It is important to note that avoidance of post mature pregnancy is a preventable factor in MAS. As far as good outcome is concerned, combined obstetric and paediatric care can lead to prevention and reduced severity of meconium aspiration syndrome with low complication rate and decrease mortality.

CONCLUSION

Pulmonary hypertension was the most common complication followed by air leak syndrome. It was more common in male patients as compared to females.

REFERENCES

1. Walsh MC, Faranoff JM. Meconium stained fluid: approach to the mother and baby. Clin Perinatol 2007; 34:653-65.

2. Vivian-Taylor J, Sheng J, Hadfield RM, Morris JM, Bowen JR, Roberts CL. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. Br J Obstet Gynae 2011; 118:1601-7.

3. Committee on obstetric Practice. American College of Obstetricians and Gynaecologists. ACOG Committee Opinion No.379: Management of delivery of a newborn with meconium stained amniotic fluid. Obstet Gynecol 2007; 110:739.

4. Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous meconium stained infant born at term. Cochrane Database Syst Rev 2001; 1:CD000500.

5. Mehar V, Agarwal N, Agarwal A, Agarwal S, Dubey N, Kumawat H. Meconiumstained amniotic fluid as a potential risk factor for perinatal asphaxia: A single center experience. J Clin Neonatol 2016; 5:157-61.

6. Wiswell TE. Advances in the treatment of meconium aspiration syndrome. Acta Pediatr 2001; 90:28-30.

7. Razzaq A. Early neonatal morbidity and mortality in meconium aspiration syndrome [dissertation]. Multan: Nishtar Medical College; 2007.

8. Velaphi S, Vidyasagar D. Intra-partum and post delivery management of infants born to mothers with meconium-stained amniotic fluid: evidence-based recommendations. Clin Perinatol 2006; 33:29-42.

9. Greenough A, Pulikot A, Dimitriov G. Prevention and management of meconium aspiration syndrome-assessment of evidence based practice. Eur J Pediatr 2005; 164:329-30.

10. Angus DC, Linde-Zwirble WT, Clermont G, Griffin MF, Clark RH. Epidemiology of neonatal respiratory failure in the United States: projections from California and New York. Am J Respir Crit Care Med 2001; 164:1154-60.

11. Dargaville PA, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies and outcome. Paediatrics 2006; 117:1712-21.

12. Diaz SH, Linda J, Marter V, Martha M, Werler CL. Risk factors for persistent pulmonary hypertension of the newborn. Paedriatics 2007; 120:272-82.
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Publication:Journal of Postgraduate Medical Institute
Article Type:Report
Date:Sep 29, 2017
Words:1275
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