Meconium Aspiration Syndrome – a 21-years’ Experience from a Tertiary Care Center and Analysis of Risk Factors for Predicting Disease Severity

Abstract

Background:

Aim of this study was to describe the course of perinatal factors in neonates with meconium aspiration syndrome (MAS) from 1990 to 2010 and to determine risk factors for a severe course of the disease.

Patients:

All neonates with MAS hospitalized in our level III neonatal intensive care unit from 1990 to 2010.

Method:

Retrospective analysis of trends of perinatal factors in neonates with MAS over time and of the association of these factors with severe MAS (need for invasive mechanical ventilation for ≥7 days, or need for high frequency oscillation or need for extracorporeal membrane oxygenation).

Results:

We included 205 neonates with MAS, 55 had severe MAS (27%). MAS incidence and absolute number of MAS cases per year decreased during the observation period (p=0.003 and 0.005, respectively) as well as rates of outborn deliveries (p=0.004), duration of invasive mechanical ventilation (p=0.004), and hospital stay (p=0.036). Incidence and absolute number of severe MAS cases per year decreased (p=0.008 and 0.006, respectively), though the percentage of severe MAS among all neonates with MAS did not change. Risk factors for severe MAS were acute tocolysis (odds ratio 18.2 (95% confidence interval 2.1–155.3), p<0.001) fetal distress (3.4 (1.8–6.4), p<0.001), and severe and moderate birth asphyxia (4.4 (2.0–9.7), p=0.001 and 2.9 (1.5–5.6), p=0.009).

Conclusion:

The incidence and absolute numbers of MAS and severe MAS cases changed during the study period as well as neonatal management. Acute tocolysis, fetal distress, and asphyxia were associated with severe MAS.

Zusammenfassung

Hintergrund:

Ziel dieser Arbeit war es, den Verlauf perinataler Faktoren bei Kindern mit Mekoniumaspirationssyndrom (MAS) im Zeitraum von 1990–2010 darzustellen sowie Risikofaktoren für einen schweren Verlauf zu identifizieren.

Patienten:

Alle Neugeborenen, die an unserer Level-III-Neugeborenenintensivstation von 1990 bis 2010 mit MAS stationär waren.

Methode:

Retrospektive Analyse perinataler Faktoren und Analyse von Risikofaktoren für ein schweres MAS (invasiv mechanische Beatmung ≥ 7 Tage oder Hochfrequenzbeatmung oder extrakorporale Membranoxygenierung).

Ergebnisse:

Von 205 Neugeborenen mit MAS hatten 55 (27%) ein schweres MAS. Die Inzidenz und die absolute Anzahl der MAS-Fälle pro Jahr sank über den Beobachtungszeitraum signifikant (p=0,003 und 0,005), ebenso der Anteil von Kindern mit MAS, die von peripheren Krankenhäusern an unser Zentrum transferiert wurden (p=0,004), die Dauer der invasiven Beatmung (p=0,004) und Hospitalisierung (p=0,036). Die Inzidenz und die absolute Anzahl schwerer MAS-Fälle nahmen über den Beobachtungszeitraum ab (p=0,008 und 0,006), nicht aber der prozentuelle Anteil schwerer Fälle unter allen Kindern mit MAS. Als Risikofaktoren für schweres MAS identifizierten wir die Akuttokolyse (Odds Ratio 18,2 (95% Konfidenzintervall 2,1–155,3), p<0,001) ein pathologisches CTG (3,4 (1,8–6,4), p<0,001), schwere und mittelgradige Asphyxie (4,4 (2,0–9,7) und 2,9 (1,5–5,6), p=0,001 bzw. p=0,009).

Schlussfolgerung:

Die Inzidenz und absolute Anzahl der MAS-Fälle sowie der schweren MAS-Fälle und ihre neonatale Behandlung veränderten sich während der letzten 21 Jahre. Akuttokolyse, ein pathologisches CTG und Asphyxie waren mit einem schweren Krankheitsverlauf assoziiert.

Key words

birth asphyxia - epidemiology - history - meconium aspiration syndrome - neonatal ventilation

Schlüsselwörter

Asphyxie - Epidemiologie - Vorgeschichte - neonatale Beatmung - Mekoniumaspirations­syndrom

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