Meconium contaminated amniotic fluid and infant otitis media. Is it a risk factor in children surviving aspiration and initial distress of respiration?
OBJECTIVE
Histological studies show that amniotic fluid cellular content (AFCC) causes in the middle ear a foreign body reaction, the extent and severity of which depends upon the massiveness of contamination. We studied how factors related to birth and environment affect proneness to acute otitis media (AOM) in infants born through meconium contaminated amniotic fluid.


METHODS
From the birth records of infants born from 1996 to 2000 a list was made of those born through meconium contaminated amniotic fluid with pulmonary aspiration and tracheal suctioning, followed by treatment in a neonatal intensive care unit. Thirty-seven such children formed the study group, 43 children matching the study cases but born through clear fluids formed the control group. Birth and environmental factors together with the frequency and number of episodes of AOM were analyzed in all, based on a verified questionnaire. In addition, 27 children in the study group and 21 in the control group received a specialist ENT examination, hearing tests and tympanometry.


RESULTS
The events at delivery were highly significantly different between the two groups, manifested by the lower Apgar points in the study group (p<0.001) while other birth and environmental factors appeared equalized. The first episode of AOM in the study group came earlier than in the control group and their frequency was significantly higher during the 1st and 2nd year of life and during the entire observation period (p<0.001). Tympanostomy was performed more often in the study group. Tympanometry showed more cases of reduced static admittance and negative pressure than in the control group and hearing was poorer.


CONCLUSIONS
Cases with compromised delivery through meconium contaminated fluids, resulting in pulmonary aspiration and in need of intensive care treatment, form a risk group, which should be closely followed. Early nasopharyngeal suctioning of AFCC may reduce its entry into the middle ear. A prolonged episode of AOM suggests mucosal involvement of several middle ear compartments, shown by histological studies to occur in all cases of massive contamination. Placement of a ventilation tube after the first prolonged AOM allows regression of the granulation tissue in the air spaces together with the secretory elements in the mucosa.
Lilja
Markus
M
Department of Otolaryngology, Helsinki University Central Hospital, Haartmaninkatu 4E, FIN-00290 Helsinki, Finland. Markus.Lilja@hus.fi
Palva
Tauno
T
Ramsay
Hans
H
Laitinen
Kalevi
K
Andersson
Sture
S
D000158:Acoustic Impedance Tests; D000653:Amniotic Fluid; D004432:Ear, Middle / Q000382:microbiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008470:Meconium; D008471:Meconium Aspiration Syndrome / Q000382:microbiology / Q000503:physiopathology*; D010033:Otitis Media / Q000453:epidemiology* / Q000209:etiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications*; D012307:Risk Factors