Meconium staining amnionic fluid ( MSAF ) is associated with tonss of inauspicious result and has long been considered to be a bad forecaster of foetal result. Meconium aspiration syndrome ( MAS ) is often associated with foetal hypoxia which promotes meconium discharge in amnionic fluid, panting and aspiration of MSAF, and besides alterations in the vascular muscular media of pneumonic arterias of the foetus. About 30 to 50 % of MAS required mechanical airing or uninterrupted positive air passage force per unit area ( CPAP ) .
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This retrospective survey was undertaken to happen out immediate foetal result in meconium stained spirits in relation to perinatal asphyxia.
MATERIAL AND METHOD: –
It was a retrospective survey. We reviewed the medical records of all Neonates admitted to neonatal intensive attention unit ( NICU ) between 1st September 2011 to 31st July 2012 at NICU of Manipal Teaching Hospital, Nepal. Gestational age of babes & lt ; 37weeks are coded as preterm, & gt ; 42weeks as station term and 37 to 42 hebdomads as term. Chi square trial and Binary logistic arrested development were used for the analysis. We calculated odds ratios ( OR ) and their 95 % assurance intervals ( 95 % CI ) . P-value
Out of 399 entire admittances in NICU, male ( 62. 4 % ) showed preponderance as compared to female ( 37. 6 % ) , among which 6. 8 % were instances of MAS, doing female ( 10. 7 % ) more prone compared to male ( 4. 4 % ) while perinatal asphyxia came out to be 11. 5 % , doing male ( 12 % ) more prone to female ( 10. 7 % ) . Post term [ odds ratio= 3. 50 ( CI: 0. 39, 31. 42 ) ] and term [ odds ratio= 2. 58 ( CI: 1. 16, 5. 75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0. 01 ) . Post term [ odds ratio= 9. 15 ( CI: 1. 91, 43. 75 ) ] and term [ odds ratio= 2. 67 ( CI: 1. 41, 5. 08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0. 01 ) . MAS babe is holding 6. 62 ( CI: 2. 85, 15. 38 ) times hazard of developing perinatal asphyxia ( p & lt ; 0. 01 ) .
MAS is a perinatal job which requires a full co-operation and coordination of Obstetrician and Pediatrician if it is to be avoided. Prompt and efficient bringing room direction can minimise the sequeale of aspirated meconium and diminish the opportunity of perinatal asphyxia.
In the early 2000, the prevalence of MAS ranged from 0. 20 % to 0. 54 % in the general population [ 2-4 ] and from 1. 0 % to 6. 8 % in babies born through MSAF [ 1, 2-4 ] . A reappraisal of 10 studies published from 1990 to 1998 showed a combined incidence of 13. 1 % for MSAF, 0. 52 % of MAS, 4. 2 % of MAS among MSAF, and 49. 7 % of MAS necessitating ventilatory support with a 4. 6 % mortality rate [ 3 ] .
However, big population-based surveies were scarce and suggested a lower incidence of MAS: the national US birth cohort survey conducted on the footing of singleton term non-Hipic white unrecorded births ( 1995-2001 ) showed that the rate of MAS markedly increased with gestational age ( GA ) , that is, from 0. 10 % at 37 hebdomads gestation ( WG ) to 0. 22 and 0. 31 % at 40 and 41 WG, severally [ 5 ] . The prevalence of MAS could be extrapolated to 0. 18 % in this population of term babies. In Australia, the rate of MAS necessitating mechanical airing in flat III units ranged between 0. 024 to 0. 046 % at 36-40 WG and so increased to 0. 080 % at 41 WG and 0. 14 % at 42 WG [ 6 ] . In France, the prevalence of automatically ventilated MAS was estimated to 0. 043 % by a retrospective national study among newborns born in 2000-2001 [ 7 ] .
Meconium-stained amnionic fluid occurs in about 13 % of unrecorded births. Meconium aspiration syndrome ( MAS ) occurs in 5 to 10 % of babies born through meconium-stained amnionic fluid. When MAS occurs, there is an addition in neonatal mortality and morbidity. Great advancement has been made in the betterment of endurance of babies with MAS. Great advancement in direction has been made since first description of the pathophysiology and hapless result of babies with MAS in 1975. [ 8 ] These include improved intrapartum and post-delivery direction of MAS. Although there is a important lessening in the happening of MAS and associated mortality in developed states MAS remains a major job in developing states.
Meconium, the faecal stuff that accumulates in the fetal colon throughout gestation, is a term derived from the Greek mekoni, intending poppy juice or opium. It is a unfertile, thick, black-green, odourless stuff foremost observed in the foetal bowel during the 3rd month of gestation. Meconium consequences from the accretion of dust, including desquamated cells from the bowel and tegument, GI mucin, lanugo hair, fatty stuff from the vernix caseosa, amnionic fluid and enteric secernments. The black-green colour consequences from bile pigments. [ 9, 10 ] Most babies have their first intestine motion after birth ( within the first 24 to 48 hour after birth ) . Occasionally a foetus can go through meconium in uteri. Aspiration of meconium and amnionic fluid can go on during any point of the labour and bringing. The foetus could draw out this mixture of fluids while they are still in the womb, coming through the birth canal, or when they take their first breathe after birth. This is referred to as Meconium Aspiration Syndrome ( MAS ) .
MAS is an of import cause of respiratory hurt in the term neonate, is a serious status with high morbidity and mortality. [ 11, 12 ] The pathophysiology is complex and non good defined, including airway obstructor, pneumonic high blood pressure, epithelial hurt, surfactant inactivation, and redness. [ 11, 13 ] Fetal asphyxia [ 14 ] and infection are suggested to be chief causative agents. [ 15, 16 ] Meconium produces inflammatory responses in both carnal theoretical accounts and neonates with MAS. [ 17 ] After intratracheal instillment of meconium in animate beings, there is an intense pneumonic inflammatory reaction with inflow of polymorphonuclear leucocytes, monocytes/macrophages, and T cells within a few hours. The production of proinflammatory
cytokines further propagates parenchymal lung cell hurt, [ 18, 19 ] and apoptotic epithelial cells are present in meconium containing lungs. [ 20, 21 ]
MAS is a disease of the term and near-term baby that is associated with considerable respiratory morbidity. The disease is characterized by early oncoming of respiratory hurt in a meconium-stained baby, with hapless lung conformity and hypoxemia clinically and patchy opacification and hyperinflation radiographically. [ 22, 23 ] At least one tierce of babies with MAS require cannulation and mechanical airing, [ 24, 25 ] and newer neonatal therapies, such as high-frequency airing ( HFV ) , inhaled azotic oxide ( iNO ) , and surfactant disposal are frequently brought into drama. [ 26, 27 ]
In the past few decennaries, there seems to hold been a decrease in the incidence of MAS in many centres, at least in the developed universe. [ 25, 28, 29 ] The evident decrease in the hazard of MAS has been attributed to better obstetric patterns, in peculiar, turning away of postmaturity and expeditious bringing where fetal hurt has been noted. [ 28 ]
This retrospective survey was undertaken to happen out immediate foetal result in meconium stained spirits in relation to perinatal asphyxia.
MATERIALS AND METHODS: –
Study design and the participants:
It was a infirmary based retrospective experimental survey conducted in the Department of Paediatrics, Manipal College of Medical Sciences ( MCOMS ) , Kathmandu University. Manipal learning infirmary ( MTH ) is a third attention infirmary in pokhara metropolis of Nepal and it is a good facilitated and equipped infirmary for patients with neonatal intensive attention unit ( NICU ) . It was chosen for the survey because Manipal learning infirmary is a third attention 825 bedded infirmary and it was expected that most of the patients will come to this infirmary from Western Nepal.
DATA COLLECTION: –
This survey was carried out from 1ST SEPTEMBER 2011to 31st JULY, 2012. The survey population included patients admitted in Pediatrics NICU from different parts of Pokhara, Nepal. After obtaining the permission from the caput of the section, information was collected from the medical record section of the patient from NICU. The variable collected were Age, sex, weight, manner of bringing and gestational age. Sum of 399 instances were included in the survey holding both meconium aspiration syndrome, perinatal asphyxia and other neonatal infections.
Gestational age of babes & lt ; 37weeks are coded as preterm, & gt ; 42weeks as station term and 37 to 42 hebdomads as term.
SAMPLE SIZE CALCULATION: To be added subsequently
To happen out immediate foetal result in meconium stained spirits in relation to perinatal asphyxia.
Factors at single degree are gestational age and sex.
ETHICAL COMMITTEE APPROVAL:
Predating the survey, blessing for the survey was obtained from the institutional research ethical commission.
DATA MANAGEMENT AND STATISTICAL ANALYSIS:
Analysis was done utilizing descriptive statistics and proving of hypothesis. The information was analyzed utilizing Excel 2003, R 2. 8. 0, Statistical Package for the Social Sciences ( SPSS ) for Windows Version 16. 0 ( SPSS Inc ; Chicago, IL, USA ) and the EPI Info 3. 5. 1 Windows Version. A p-value of & lt ; 0. 05 ( two-tailed ) was used to set up statistical significance. [ 30, 31 ]
Table 1depicts: female ( 10. 7 % ) more prone compared to male ( 4. 4 % ) . Post term [ odds ratio= 3. 50 ( CI: 0. 39, 31. 42 ) ] and term [ odds ratio= 2. 58 ( CI: 1. 16, 5. 75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0. 01 ) . from the above statistics it ‘s really clear the female in our survey are doing an dominant portion as compared to do in meconium aspiration syndrome. Along with this, we can do out that station and term newborns are holding larger hazard of developing meconium aspiration syndrome.
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Table 2: shows Perinatal asphyxia came out to be 11. 5 % , doing male ( 12 % ) more prone to female ( 10. 7 % ) .
Post term [ odds ratio= 9. 15 ( CI: 1. 91, 43. 75 ) ] and term [ odds ratio= 2. 67 ( CI: 1. 41, 5. 08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0. 01 ) . MAS babe is holding 6. 62 ( CI: 2. 85, 15. 38 ) times hazard of developing perinatal asphyxia ( p & lt ; 0. 01 ) .
From the tabular array we formulated that male are holding more hazard of developing perinatal asphyxia as compared to females. post term babes and term are holding greater hazard holding asphyxia.
Therefore from the above consequence we can do out that there is strong relationship between MAS and perinatal asphyxia i. e, meconium aspiration newborns are prone for developing perinatal asphyxia.
The increased hazard for pneumonic morbidity and mortality among babies born through meconium stained amnionic fluid is good recognized. Though many studies have noted a clinical spectrum of pneumonic disfunction such as mild tachypnea and terrible pneumonic inadequacy, this survey confirms that meconium stained amnionic fluid is associated with an increased hazard for pneumonic disfunction. The hazard for pneumonic disease, nevertheless, is non manifested every bit in all babies with meconium staining. As it was shown by several old surveies, the greatest hazard for pneumonic disease occurred among babies with associated marks of possible intrapartum foetal via media. Despite airway direction following recommended guidelines, these babies continued to attest a high rate of pneumonic morbidity [ 32-35 ] .
The recommendation by the American Academy of Pediatrics in 1983 did non propose that all babies born through thick meconium stained amnionic fluid needfully necessitate tracheal suction. The 2nd edition of these Guidelines noted the absence of extra surveies to back up or rebut the pattern of tracheal suction for meconium stained amnionic fluid and recommended that “ in the presence of midst or particulate meconium, the voice box should be visualized, and if meconium is present, the clinician should cannulate the windpipe and use suction ” . The most recent edition of the Guidelines published in 1992, is downwind dogmatic. It is recommended that down babies with meconium in the hypopharynx have tracheal suction. However, it is further noted that cord visual image and tracheal suction in the vigorous baby with thick meconium may non be necessary. None of the Guidelines have recommended tracheal suction of babies born through thin meconium stained amnionic fluid [ 32, 33 ] .
MECONIUM ASPIRATION SYNDROME WITH GESTATIONAL AGE:
The overall incidence of MAS and terrible MAS additions with GA as reported in recent population-based surveies [ 36, 37 ] . The overall rates of MAS in the USA [ 36 ] and Burgundy are similar: 1. 0 versus 1. 1 per 1000 unrecorded births ( aˆ° ) at 37 hebdomads ; 1. 1 versus 1. 0aˆ° at 38weeks ; 1. 5 versus 1. 1aˆ° at 39weeks ; 2. 2 versus 2. 4aˆ° at 40 hebdomads, and 3. 1 versus 2. 6aˆ° at 41weeks. Furthermore the incidence of terrible MAS recorded in Australia [ 37 ] at 41weeks ( 0. 80aˆ° ) is close to the 0. 67aˆ° observed at 39-41weeks in our series. Some surveies suggested that bar of post term gestation prevents terrible MAS [ 38 ] . Our retrospective observational survey showed that station term [ odds ratio= 3. 50 ( CI: 0. 39, 31. 42 ) ] and term [ odds ratio= 2. 58 ( CI: 1. 16, 5. 75 ) ] babes were holding more hazard of developing MAS compared to preterm ( P & lt ; 0. 01 ) .
MECONIUM ASPIRATION SYNDROME WITH SEX:
In our survey, male ( 62. 4 % ) showed preponderance as compared to female ( 37. 6 % ) , among which ( 6. 8 % ) were instances of MAS, doing female ( 10. 7 % ) more prone compared to male ( 4. 4 % ) .
PERINATAL ASPHYXIA WITH GESTATIONAL AGE:
For more than two decennaries, post term gestation has been defined as a gestation that persists beyond 294 yearss or 42 hebdomads of gestation [ 39 ] . The most common ground to name it is inaccurate gestation dating. Last catamenial period with regular catamenial rhythm is the best physiological landmark to measure the gestational age in gestation. However, a few adult females are certain of their day of the months and frequently cause anxiousness when they come with postdates [ 40 ] . The cause of post-term gestation is unknown. A Post term gestations are associated with higher hazard of perinatal mortality and morbidity including meconium aspiration syndrome, A asphyxia neonatrum respiratory hurt syndrome, icterus neonatrum, sepsis neonatorum, oligohydramnios, macrosomia, foetal birth hurt, foetal hurt and increased rate of cesarean subdivision [ 41 ] . Our survey showed that station term [ odds ratio= 9. 15 ( CI: 1. 91, 43. 75 ) ] and term [ odds ratio= 2. 67 ( CI: 1. 41, 5. 08 ) ] babes were holding more hazard of developing perinatal asphyxia compared to preterm ( P & lt ; 0. 01 ) .
PERINATAL ASPHYXIA WITH SEX:
In legion surveies, asphyxia was more prevailing in male than female [ 42, 43, 44 ] . In our survey, male preponderance is seen. Out of 399 instances perinatal asphyxia came out to be 11. 5 % , doing male ( 12 % ) more prone to female ( 10. 7 % ) .
The present survey showed a good correlativity of prevalence of meconium aspiration syndrome and perinatal asphyxia both in term and post term babes doing perinatal asphyxia more common in meconium aspiration syndrome.
There is demand of a big randomized controlled test to analyze the functions of intrapartum nasopharyngeal and immediate postpartum tracheal suctioning in newborns born through MSAF in developing state scene.
Conflict OF INTERESTS:
The writers do non hold any struggle of involvement originating from the survey.
Dr. K. S RAO, Professor and Head of Department, Pediatrics, Manipal College of Medical Sciences, Pokhara ( Nepal ) for allowing the writers to utilize the infirmary paperss during the survey.
What this survey adds:
By agencies of this survey we can turn out that perinatal asphyxia is more prevailing in meconium aspiration syndrome.