exudates and Meconium-Aspiration-Syndrome

The outcome in 148 inborn meconium-stained neonates was studied prospectively over a 5-month period. Fifty-three infants (38.5%) developed meconium aspiration syndrome (MAS). There was a significantly higher rate of MAS (p < 0.001), mechanical ventilation (p < 0.016) and hospital stay (p < 0.016) in neonates with meconium in the trachea than in neonates with no meconium in the oropharynx. The incidence of MAS was significantly higher and the duration of hospital stay longer in outborn than in inborn infants (p < 0.022).. Between January 1 and May 31, 1991, of a total 975 admissions, 164 (79 boys, 85 girls) meconium-stained neonates were admitted to the neonatal nursery of the Hospital Universiti Sains Malaysia (HUSM) within 12 hours of delivery. (148 born at HUSM, 16 born outside the hospital). 56 (38%) of the inborn infants were found to have meconium in the trachea. A total of 64 neonates developed meconium aspiration syndrome (MAS) of whom 53 were inborn and 11 outborn. Of the 53 inborn neonates with MAS, only 31 had meconium in the trachea. 6 neonates who had positive blood cultures were excluded from the MAS group. The organisms isolated were group B Streptococcus, Staphylococcus epidermidis, and Klebsiella species. The average birth weight of the neonates with MAS was 3.320 kg (range 1.950-4.800 kg). Five babies, whose weights fell below the 10th percentile for their gestational ages, were considered small for gestational age (SGA); 36 were postterm, 25 were term, and 3 were preterm. 11 neonates required mechanical ventilation. Mean duration of ventilation was 4.82 days (range: 1-12 days). 8 infants developed complications including persistent fetal circulation, pneumothorax, and acute renal failure. One baby who had severe birth asphyxia developed cerebral palsy. Three mothers of the neonates with MAS had prolonged rupture of membranes, 3 had prolonged labor, and 6 had pyrexia at the time of delivery. Three neonates (2 girls, 1 boy) died. Two were delivered at home and 1 at HUSM. 11 of the 16 meconium-stained infants born outside developed MAS. Three of them required mechanical ventilation, all developed complications, and 2 of them died. The risk of MAS was twice as great when meconium was present in the trachea than when it was not, but the absence of meconium from the oropharynx did not guarantee freedom from MAS. Babies born outside the hospital had very high morbidity.

Topics: Developing Countries; Female; Humans; Incidence; Infant, Newborn; Length of Stay; Malaysia; Male; Meconium Aspiration Syndrome; Prospective Studies; Respiration, Artificial

In view of controversial reports about the role of prelabour rupture of foetal membranes (PROM) in neonatal morbidity and to study the association of PROM with infections and meconium aspiration syndrome (MAS), a prospective case control study was conducted in a level II nursery of Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Of the 111 neonates with PROM studied, 18 developed clinical problems (septicaemia and other specific problems such as pneumonia, omphalitis, skin infection and MAS) while 5/56 of the control group developed similar problems. The difference between the two groups was not significant (p < 0.30). There was no neonatal death. It is concluded that PROM is not associated with neonatal morbidity. Neonates with this problem alone do not need to be admitted to the neonatal nursery.

Topics: Case-Control Studies; Cross Infection; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Malaysia; Male; Meconium Aspiration Syndrome; Morbidity; Patient Admission; Pregnancy; Prospective Studies; Risk Factors; Rural Population; Socioeconomic Factors