Volume : VIII, Issue : XII, December - 2019

STUDY OF NEONATES WITH MECONIUM ASPIRATION SYNDROME

Dr. Archana N. Shah, Dr. Dharaben Desai, Dr. Sweety M. Patel, Dr. Rajal B. Prajapati, Dr. Riya Patel, Dr. Dipkala Jayswal

Abstract :

INTRODUCTION: Meconium aspiration syndrome (MAS) , a major cause of perinatal morbidity and mortality. MSAF is reported to occur in 12–15% of all pregnancies. MSAF cause mechanical airway obstruction with or without air leaks,pneumonitis and surfactant inactivity leading to MAS which seen in 5% pregnancy2. Several maternal as well as neonatal risk factors have been reported to be associated with MAS like nulliparity,ethnicity,gestational age>41weeks, SGA, low APGAR score and mean low cord PH. All of these lead to complication like PPHN,respiratory failure ,myocardial damage in which PPHN is major cause of morbidity and mortality. MATERIAL AND METHOD: It was an Observational analytical study, conducted for 2 year. All neonates admitted in neonatal care unit of tertiary care center with Meconium aspiration syndrome were randomly enrolled. Babies born through vigorous MSL were sent to post–natal ward after ief observation period (1 hr). Non–vigorous MSL babies were admitted in SNCU for post–resuscitation care. Written and informed consent obtained from their parents/guardians for using the case data for research purposes. Details of the patients collected from the case reporting files. Proforma was filled, analysed statistically and conclusion derived. RESULTS: Total 960 neonates(intramural–620 as well as referred from outside–340) were admitted in SNCU. Out of which MAS accounted for 4.1%. Out of 620 hospital born admissions, 175(28%) were non –vigorous MSL babies out of which 30(17.1%) babies developed MAS. 14(35%) patients had mild MAS, 10(25%) patients had moderate MAS while 16(40%) patients had severe MAS. 65% were male and 35% were female suggesting 1.8:1 male preponderence. 85% patients with MAS were AGA while 15% patients were SGA. pH alteration (Metabolic acidosis) was found in all patients. We have observed maternal complication like PIH, age<20 year,oligohydroamnios and PROM.All patient required respiratory support. We have observed complications like PPHN(M/C),pnemothorax,septisemia,myocardial dysfunction.Mortality is more with patient having complication. CONCLUSION: Babies with non vigorous MSL accounted for 28% of total intramural NICU admissions out of which 17.1% developed MAS. This was 4.1% of total NICU admissions.1.8:1 male preponderance. Most of the patients were full term with average gestational age of 38.3 weeks and birth weight >2000gms and were AGA babies and delivered normally. Significant maternal factors were primi gravida(44%), PIH(23%), prolonged labour (17.5%), age<20 year(16.5%), h/o oligohydroamnios (15%). Other risk factors in decreasing order of frequency were post date, severe anemia, PROM, maternal age more than 30, eclampsia and diabetes.All patient showed metabolic acidosis(pH <7.35). Patients with mild MAS had pH in range of 7.35–7.20(mild acidosis) and moderate/ severe MAS had pH in range of <7.20.( both p value <0.0001).Complications observed were PPHN (30%) , Septicemia (20%) , Pneumothorax (15%) and Myocardial dysfunction (5%).Most patients were managed with supplemental Oxygen while some required CPAP ,Ventilatory care and surfactant therapy and very few of them needed HFOV.PPHN and Pneumothorax were major complications causing mortality and were significantly associated with severity of MAS( p value <0.0001). Septicemia and myocardial dysfunction were also noted.Mortality was 25%. All of them were having severe MAS.

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Article: Download PDF    DOI : 10.36106/ijsr  

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STUDY OF NEONATES WITH MECONIUM ASPIRATION SYNDROME, DR. ARCHANA N. SHAH, DR. DHARABEN DESAI, DR. SWEETY M. PATEL, DR. RAJAL B. PRAJAPATI, DR. RIYA PATEL, DR. DIPKALA JAYSWAL INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH : Volume-8 | Issue-12 | December-2019

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