High Asparatate Aminotransferase Level Predicts Poor Neurodevelopmental Outcome in Infants with Meconium Aspiration Syndrome

I-Lun Chen; Mei-Chen Ou-Yang; Feng-Shun Chen; Mei-Yung Chung; Chih-Cheng Chen; Hsin-Chun Huang

doi:10.1055/s-0033-1363164

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2014; 31(10): 845-850
DOI: 10.1055/s-0033-1363164

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

High Asparatate Aminotransferase Level Predicts Poor Neurodevelopmental Outcome in Infants with Meconium Aspiration Syndrome

Autoren

I-Lun Chen

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Mei-Chen Ou-Yang

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Feng-Shun Chen

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Mei-Yung Chung

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Chih-Cheng Chen

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
Hsin-Chun Huang

¹Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan

Abstract

Objective The aim of our study is to clarify the perinatal predictive factors of meconium aspiration syndrome (MAS) with neurodevelopmental delay (ND) in infants.

Materials and Methods In this retrospective study, data were collected from the infants born between 1990 and 2008. They all had primary diagnosis of MAS. Multivariable analyzed perinatal predictive factors of MAS with ND. The developmental status of these infants was followed at least 2 years with the Wechsler Intelligence Scale for Children.

Results A total of 114 surviving babies met the criteria of MAS. Six babies were defined as ND group. Lower 5-mintue Apgar score and diastolic blood pressure were significantly related to the ND group. Elevated asparatate aminotransferase (AST), nucleated red blood cells, and white blood cells at the time of admission were significantly high in ND group. Furthermore, AST had area under the receiver operating characteristic curve of 0.879, (95% confidence interval: 0.801, 0.934), p < 0.0001. At 96 mg/dL, it had 83.33% sensitivity, 80.81% specificity, and negative predictive value of 98.8. Multivariable logistic regression analysis revealed AST was the only significant predictive factor for MAS with ND.

Conclusion Early intervention should be recommended in infants having MAS with high AST level at birth for improving their neurodevelopmental outcomes.

Keywords

asparatate aminotransferase - meconium aspiration syndrome - neurology - liver

Volltext

Referenzen

References
1 Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998; 45 (3) 511-529
2 Ghidini A, Spong CY. Severe meconium aspiration syndrome is not caused by aspiration of meconium. Am J Obstet Gynecol 2001; 185 (4) 931-938
3 Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference?. Pediatrics 1990; 85 (5) 715-721
4 Yoder BA, Kirsch EA, Barth WH, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol 2002; 99 (5 Pt 1) 731-739
5 Dargaville PA, Copnell B ; Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006; 117 (5) 1712-1721
6 Swaminathan S, Quinn J, Stabile MW, Bader D, Platzker AC, Keens TG. Long-term pulmonary sequelae of meconium aspiration syndrome. J Pediatr 1989; 114 (3) 356-361
7 Macfarlane PI, Heaf DP. Pulmonary function in children after neonatal meconium aspiration syndrome. Arch Dis Child 1988; 63 (4) 368-372
8 Marshall R, Tyrala E, McAlister W, Sheehan M. Meconium aspiration syndrome. Neonatal and follow-up study. Am J Obstet Gynecol 1978; 131 (6) 672-676
9 Beligere N, Rao R. Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol 2008; 28 (Suppl. 03) S93-S101
10 Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero: mechanisms, consequences, and management. Obstet Gynecol Surv 2005; 60 (1) 45-56 , quiz 73–74
11 Abramovich DR, Gray ES. Physiologic fetal defecation in midpregnancy. Obstet Gynecol 1982; 60 (3) 294-296
12 Li ZG, Ye WF, Wen FQ, Ding HS. Regional cerebral oxygen saturation in neonates with meconium aspiration syndrome [in Chinese]. Zhongguo Dang Dai Er Ke Za Zhi 2006; 8 (3) 191-194
13 Dollberg S, Livny S, Mordecheyev N, Mimouni FB. Nucleated red blood cells in meconium aspiration syndrome. Obstet Gynecol 2001; 97 (4) 593-596
14 Hermansen MC. Nucleated red blood cells in the fetus and newborn. Arch Dis Child Fetal Neonatal Ed 2001; 84 (3) F211-F215
15 Fischbach FT, Dunning III MB. A Manual of Laboratory and Diagnostic Tests. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008: 420-422
16 Hankins GD, Koen S, Gei AF, Lopez SM, Van Hook JW, Anderson GD. Neonatal organ system injury in acute birth asphyxia sufficient to result in neonatal encephalopathy. Obstet Gynecol 2002; 99 (5 Pt 1) 688-691
17 Tarcan A, Tiker F, Güvenir H, Gürakan B. Hepatic involvement in perinatal asphyxia. J Matern Fetal Neonatal Med 2007; 20 (5) 407-410
18 Ikeda T, Murata Y, Quilligan EJ, Parer JT, Murayama T, Koono M. Histologic and biochemical study of the brain, heart, kidney, and liver in asphyxia caused by occlusion of the umbilical cord in near-term fetal lambs. Am J Obstet Gynecol 2000; 182 (2) 449-457
19 Bergounioux J, Franchi-Abella S, Monneret S, Essouri S, Jacquemin E. Neonatal ischemic liver failure: potential role of the ductus venosus. J Pediatr Gastroenterol Nutr 2004; 38 (5) 542-544
20 Meydanli MM, 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 (1) 9-15
21 Fraser WD, Hofmeyr J, Lede R , et al; Amnioinfusion Trial Group. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med 2005; 353 (9) 909-917
22 Lin HC, Su BH, Lin TW, Peng CT, Tsai CH. Risk factors of mortality in meconium aspiration syndrome: review of 314 cases. Acta Paediatr Taiwan 2004; 45 (1) 30-34
23 Clark RH, Yoder BA, Sell MS. Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation. J Pediatr 1994; 124 (3) 447-454
24 Wiswell TE, Knight GR, Finer NN , et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109 (6) 1081-1087
25 Dargaville PA, Copnell B, Mills JF , et al; lessMAS Trial Study Group. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. J Pediatr 2011; 158 (3) 383-389 , e2
26 Shah PS. Hypothermia: a systematic review and meta-analysis of clinical trials. Semin Fetal Neonatal Med 2010; 15 (5) 238-246