title: Respiratory distress including meconium aspiration syndrome in vigorous neonates born through meconium stained amniotic fluid: incidence, onset, severity and predictors at birth.
abstract: OBJECTIVE
  This study aimed to find out incidence, predictors, onset and severity of respiratory distress including meconium aspiration syndrome (MAS) among vigorous neonates born through meconium stained amniotic fluid (MSAF), which may or may not be evident at birth.
  
  
  METHODS
  Two hundred ninety vigorous neonates were studied. Data were collected on perinatal risk factors, clinical course and development of respiratory distress. Predictors of respiratory distress were identified by logistic regression and a score based on adjusted OR was assigned for each. Diagnostic performance of the score (0-24) was assessed on another 247 vigorous neonates using receiver operator characteristic analysis (ROC).
  
  
  RESULTS
  Respiratory distress developed in 97(33.4 %) infants, MAS in 75(25.9 %). The distress appeared within 12 h in 97.9 %, was severe in only 21.7 %. Of 10 risk factors significantly associated with respiratory distress, seven entered in regression analysis. Fetal distress(adj OR = 11.8; 95%CI = 6.2-22.5), prolonged labor(adj OR = 5.2; 95%CI = 2.5-10.7), and absent/poor cry(adj OR = 5.6; 95%CI = 2.4-13.3) were identified as independent predictors; each assigned a score of 12, 6 and 6, respectively. To predict respiratory distress, a cut-off score of 9 points had sensitivity-74.1 % (95%CI = 63.3 %-82.7 %), specificity-84.6 % (95 % CI = 77.9 %-89.6 %), positive predictive value- 71.6 % (95%CI = 60.8 %-80.4 %), negative predictive value- 86.2 % (95 % CI = 79.6 %-90.9 %), likelihood ratio (LR) + ve 4.8(95%CI = 3.3-7.0) and LR-ve 0.3(95%CI = 0.2-0.4).
  
  
  CONCLUSIONS
  Respiratory distress occurred in one third neonates, mostly had onset within 12 h of birth, and it was mild to moderate in majority. Fetal distress, prolonged labor, and absent/poor cry predicted respiratory distress and were validated. However, larger studies in different settings are required to confirm its utility.
authors.affiliation: Department of Pediatrics, Chhatrapati Shahuji Maharaj Medical University (erstwhile K.G.M.C.), Lucknow 226003, Uttar Pradesh, India. drsn.singh@rediffmail.com
authors.forename: S N
authors.initials: SN
authors.lastname: Singh
authors.forename: Roli
authors.initials: R
authors.lastname: Srivastava
authors.forename: Anita
authors.initials: A
authors.lastname: Singh
authors.forename: M
authors.initials: M
authors.lastname: Tahazzul
authors.forename: Mala
authors.initials: M
authors.lastname: Kumar
authors.forename: Chandra
authors.initials: C
authors.lastname: Kanta
authors.forename: S
authors.initials: S
authors.lastname: Chandra
mesh_terms: D000653:Amniotic Fluid; D001034:Apgar Score; D005260:Female; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D008470:Meconium; D008471:Meconium Aspiration Syndrome / Q000150:complications* / Q000453:epidemiology / Q000628:therapy; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D012307:Risk Factors