Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources.
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. Thirty-one 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=0.001). Postdates, inadequate intrapartum monitoring and limited use of adjunct respiratory therapies were common. Severe MAS is associated with adverse outcome.
Velaphi
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Department of Paediatrics, Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa. velaphisc@medicine.wits.ac.za
Van Kwawegen
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D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D010547:Persistent Fetal Circulation Syndrome / Q000209:etiology*; D011295:Prenatal Care; D012121:Respiration, Artificial; D012189:Retrospective Studies; D016896:Treatment Outcome