Abstract
Background
Meconium aspiration syndrome (MAS) is a significant cause of mortality and morbidity in term and post-term neonates born through meconium-stained amniotic fluid (MSAF). Numerous antenatal and intrapartum risk factors are associated with mortality, and it is crucial for obstetricians to avoid these risk factors and for neonatologists to institute adequate therapy to improve outcomes.
Aim
To determine the predictors of mortality in neonates with meconium aspiration syndrome
Methods
This retrospective study reviewed data from four regional hospitals over three years from 01 January 2015 to 31 December 2017. During the study period, data were recorded with regard to sex, mode of delivery, gestational age, maternal age, asphyxia, Apgar score at one and five minutes, persistent pulmonary hypertension, and respiratory support of neonates with MAS.
Results
Of the 187 neonates identified with MAS, 30 died, with a case fatality rate of 16%. Ninety-seven (51.9%) neonates were diagnosed with asphyxia, 91 (48.7%) with seizures, and 55 (27.3%) with PPHN. The factors associated with mortality were male sex (p = 0.009), a low Apgar (< 7 at five minutes) (p = 0.003), asphyxia (p ≤ 0.001), any form of resuscitation (p = 0.003 and < 0.001), bag-mask ventilation (BMV) and cardiac massage, respectively, and the presence of PPHN (p = 0.007) and air leakage (p = 0.002). After adjusting for all variables, the presence of asphyxia and air leakage were significantly associated with mortality, with ORs of 39.79 (3.93–1151) and 79.46 (3.53–2985), respectively.
Conclusion
Meconium aspiration syndrome is a significant cause of mortality. Asphyxia and air leakage are significant contributors to mortality in neonates with MAS. Continuous fetal monitoring, early recognition of fetal distress, and timely intervention during the intrapartum period are crucial for preventing asphyxia. Postnatally, neonates with MAS should be managed appropriately to prevent PPHN and air leakage, and seizures should be well controlled.