Risk Factors for Early and Late Onset of Respiratory Symptoms in Babies Born through Meconium

ABSTRACT

We sought (1) to identify risk factors for meconium aspiration syndrome (MAS) among infants born to women whose labors were complicated by thick-consistency meconium-stained amniotic fluid (MSAF), and (2) to determine whether risk factors and infant prognosis differ according to the time of onset of respiratory distress. We performed a secondary analysis of a multicenter randomized trial of amnioinfusion (AI) for the prevention of MAS among women with thick-consistency MSAF. MAS was defined as onset of respiratory distress requiring oxygen supplementation within the first 4 hours of life. Patients with respiratory symptoms with onset at ≥4 hours were treated as a separate outcome category, “late-onset respiratory distress.” We developed peripartum and intrapartum regression models to identify the risk of MAS and its subgroups. A tracing with marked abnormalities was a significant risk factor for moderate/severe MAS, but not for mild MAS or for late-onset respiratory distress. Meconium below the vocal cords and need for resuscitation immediately after birth were risk factors for mild and moderate/severe MAS as well as for late-onset respiratory distress. The risk of nonrespiratory comorbidities varied directly according to the severity of the respiratory distress. Late-onset respiratory distress shares several risk factors with MAS, as defined by Rossi et al. The two conditions may represent different manifestations of the same disease process.

KEYWORDS

Meconium-stained amniotic fluid - meconium aspiration syndrome

REFERENCES

• 1 Cleary G M, Wiswell T E. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update.  Pediatr Clin North Am. 1998;  45 511-529
• 2 Wiswell T E, Tuggle J M, Turner B S. Meconium aspiration syndrome: have we made a difference?.  Pediatrics. 1990;  85 715-721
• 3 Brown B L, Gleicher N. Intrauterine meconium aspiration.  Obstet Gynecol. 1981;  57 26-29
• 4 Davis R O, Philips III J B, Harris Jr B A, Wilson E R, Huddleston J F. Fatal meconium aspiration syndrome occurring despite airway management considered appropriate.  Am J Obstet Gynecol. 1985;  151 731-736
• 5 Urbaniak K J, McCowan L M, Townend K M. Risk factors for meconium-aspiration syndrome.  Aust N Z J Obstet Gynaecol. 1996;  36 401-406
• 6 Fliman P J, deRegnier R A, Kinsella J P, Reynolds M, Rankin L L, Steinhorn R H. Neonatal extracorporeal life support: impact of new therapies on survival.  J Pediatr. 2006;  148 595-599
• 7 Bhutani V K, Chima R, Sivieri E M. Innovative neonatal ventilation and meconium aspiration syndrome.  Indian J Pediatr. 2003;  70 421-427
• 8 Wiswell T E. Advances in the treatment of the meconium aspiration syndrome.  Acta Paediatr Suppl. 2001;  90 28-30
• 9 Rossi E M, Philipson E H, Williams T G, Kalhan S C. Meconium aspiration syndrome: intrapartum and neonatal attributes.  Am J Obstet Gynecol. 1989;  161 1106-1110
• 10 Fraser W D, Hofmeyr J, Lede R Amnioinfusion Trial Group et al. Amnioinfusion for the prevention of the meconium aspiration syndrome.  N Engl J Med. 2005;  353 909-917
• 11 National Institute of Child Health and Human Development Research Planning Workshop . Electronic fetal heart rate monitoring: research guidelines for interpretation.  Am J Obstet Gynecol. 1997;  177 1385-1390
• 12 Low J A, Victory R, Derrick E J. Predictive value of electronic fetal monitoring for intrapartum fetal asphyxia with metabolic acidosis.  Obstet Gynecol. 1999;  93 285-291
• 13 Liu W F, Harrington T. Delivery room risk factors for meconium aspiration syndrome.  Am J Perinatol. 2002;  19 367-378
• 14 Dargaville P A, Copnell B. Australian and New Zealand Neonatal Network . The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome.  Pediatrics. 2006;  117 1712-1721
• 15 Carson B S, Losey R W, Bowes Jr W A, Simmons M A. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome.  Am J Obstet Gynecol. 1976;  126 712-715
• 16 Yeh T F, Harris V, Srinivasan G, Lilien L, Pyati S, Pildes R S. Roentgenographic findings in infants with meconium aspiration syndrome.  JAMA. 1979;  242 60-63
• 17 Peng T C, Gutcher G R, Van Dorsten J P. A selective aggressive approach to the neonate exposed to meconium-stained amniotic fluid.  Am J Obstet Gynecol. 1996;  175 296-301 discussion 301-303
• 18 Ghidini A, Spong C Y. Severe meconium aspiration syndrome is not caused by aspiration of meconium.  Am J Obstet Gynecol. 2001;  185 931-938
• 19 Petrova A, Demissie K, Rhoads G G, Smulian J C, Marcella S, Ananth C V. Association of maternal fever during labor with neonatal and infant morbidity and mortality.  Obstet Gynecol. 2001;  98 20-27
• 20 Dooley S L, Pesavento D J, Depp R, Socol M L, Tamura R K, Wiringa K S. Meconium below the vocal cords at delivery: correlation with intrapartum events.  Am J Obstet Gynecol. 1985;  153 767-770
• 21 Meydanli M M, Dilbaz B, Calişkan E, Dilbaz S, Haberal A. Risk factors for meconium aspiration syndrome in infants born through thick meconium.  Int J Gynaecol Obstet. 2001;  72 9-15
• 22 Starks G C. Correlation of meconium-stained amniotic fluid, early intrapartum fetal pH, and Apgar scores as predictors of perinatal outcome.  Obstet Gynecol. 1980;  56 604-609
• 23 Krebs H B, Petres R E, Dunn L J, Jordaan H V, Segreti A. Intrapartum fetal heart rate monitoring. III. Association of meconium with abnormal fetal heart rate patterns.  Am J Obstet Gynecol. 1980;  137 936-943
• 24 Hernández C, Little B B, Dax J S, Gilstrap III L C, Rosenfeld C R. Prediction of the severity of meconium aspiration syndrome.  Am J Obstet Gynecol. 1993;  169 61-70
• 25 Coltart T M, Byrne D L, Bates S A. Meconium aspiration syndrome: a 6-year retrospective study.  Br J Obstet Gynaecol. 1989;  96 411-414
• 26 Wiswell T E, Gannon C M, Jacob J et al.. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial.  Pediatrics. 2000;  105(1 Pt 1) 1-7
• 27 Usta I M, Mercer B M, Sibai B M. Risk factors for meconium aspiration syndrome.  Obstet Gynecol. 1995;  86 230-234