Eva Gauchan^1,, Sahisnuta Basnet¹, Tejesh Malla¹

Meconium staining of amniotic fluid occurs in 10-15% deliveries and meconium aspiration syndrome occurs in 5% of those deliveries. Aspiration of meconium into the trachea results in various short and long term morbidities and variable mortality. These can be prevented by timely interventions before and after delivery. Aim of this study was to identify the neonatal factors associated with meconium aspiration syndrome and factors associated with mortality in these babies. The study included all babies admitted for meconium staining of amniotic fluid during the period of August 2013 till December 2014. Meconium aspiration syndrome was diagnosed if respiratory distress occurred immediately to within 24 hours after birth in a meconium stained baby, with radiological evidence of aspiration into the lungs and need for supplemental oxygen, after exclusion of other causes of respiratory distress. Data was analyzed by SPSS version 19 and presented as actual numbers and percentages. Associated factors were presented as Odds Ratio (OR) and 95% Confidence Interval. Chi-square test was done where applicable and a p-value <0.05 was taken as significant. Meconium aspiration syndrome was diagnosed in 50 out of 78 admitted newborns. Factors associated with meconium aspiration syndrome were respiratory distress starting immediately after birth, admission Downe score >4 and abnormal chest x-ray findings. Factors associated with mortality were small for gestational age newborns, 5 minute APGAR score <7, severe hypoxic ischemic encephalopathy, requirement for bag-mask ventilation and chest compression at birth and need for assisted ventilation. Neonatal morbidity and mortality in meconium aspiration syndrome is preventable by proper antenatal care and timely intervention after birth. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which contribute to the mortality. Those babies having risk for adverse outcome should be managed with special focus on respiratory care with use of assisted ventilation and inhaled nitric oxide and extracorporeal membrane oxygenation, where available.

meconium aspiration syndrome, neonates, Nepal