Risk factors differentiating mild/moderate from severe meconium aspiration syndrome in meconium-stained neonates
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Objective The aim of this study was to compare the risk factors associated with mild/moderate meconium aspiration syndrome (MAS)with those associated with severe in meconium-stained term neonates. Methods Consecutive singleton term neonates (n=671) with meconium staining at birth from all deliveries (n=14,666) in our institutionfrom January 2006 to December 2012 were included. Both maternal and neonatal variables were examined. Among thestudy population, for women who underwent the trial of labor (n=644), variables associated with labor were also examined. These variables were compared between the mild/moderate MAS group, the severe MAS group, and the MAS-absent group. Results MAS developed in 10.6% (71/671) of neonates with meconium staining at birth. Among the neonates with MAS,81.7% had mild MAS, 5.6% had moderate MAS, and 12.7% had severe MAS. The presence of minimal variabilitywas significantly increased in both the mild/moderate and the severe MAS groups. The frequencies of nulliparity,fetal tachycardia, and intrapartum fever were significantly increased in the mild/moderate MAS group, but not inthe severe MAS group. While a longer duration of the second stage of labor was significantly associated with mild/moderate MAS, severe MAS was associated with a shorter duration of the second stage. Notably, low mean cord pH(7.165 [6.850–7.375]) was significantly associated with mild/moderate MAS, but not with severe MAS (7.220 [7.021–7.407]) compared with the absence of MAS (7.268 [7.265–7.271]). Conclusion Our data suggest the development of severe MAS is not simply a linear extension of the same risk factors driving mild/moderate MAS.
Abstract
Objective The aim of this study was to compare the risk factors associated with mild/moderate meconium aspiration syndrome (MAS)with those associated with severe in meconium-stained term neonates. Methods Consecutive singleton term neonates (n=671) with meconium staining at birth from all deliveries (n=14,666) in our institutionfrom January 2006 to December 2012 were included. Both maternal and neonatal variables were examined. Among thestudy population, for women who underwent the trial of labor (n=644), variables associated with labor were also examined. These variables were compared between the mild/moderate MAS group, the severe MAS group, and the MAS-absent group. Results MAS developed in 10.6% (71/671) of neonates with meconium staining at birth. Among the neonates with MAS,81.7% had mild MAS, 5.6% had moderate MAS, and 12.7% had severe MAS. The presence of minimal variabilitywas significantly increased in both the mild/moderate and the severe MAS groups. The frequencies of nulliparity,fetal tachycardia, and intrapartum fever were significantly increased in the mild/moderate MAS group, but not inthe severe MAS group. While a longer duration of the second stage of labor was significantly associated with mild/moderate MAS, severe MAS was associated with a shorter duration of the second stage. Notably, low mean cord pH(7.165 [6.850–7.375]) was significantly associated with mild/moderate MAS, but not with severe MAS (7.220 [7.021–7.407]) compared with the absence of MAS (7.268 [7.265–7.271]). Conclusion Our data suggest the development of severe MAS is not simply a linear extension of the same risk factors driving mild/moderate MAS.
참고문헌 (40)
- Singh BS., "Meconium aspiration syndrome remains a significant problem in the NICU : outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period", J Perinatol, 29, pp.497~503 (2009)
- Beligere N., "Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review", J Perinatol, 28(Suppl 3), pp.S93~S101 (2008)
- Espinheira MC., "Meconium aspiration syndrome : the experience of a tertiary center", Rev Port Pneumol, 17, pp.71~76 (2011)
- Anwar Z., "Mortality in meconium aspiration syndrome in hospitalized babies", J Coll Physicians Surg Pak, 21, pp.695~699 (2011)
- Velaphi S., "Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources", J Perinatol, 28(Suppl 3), pp.S36~S42 (2008)
- 오수영, "분만 관련 불가항력적인 의료사고에 대한 의학적 이해: 양수색전증, 폐색전증, 태변흡인증후군과 뇌성마비에 관하여", 대한의사협회지, 56(9), pp.784~804 (2013), 대한의사협회
- Fischer C., "A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation", Int J Pediatr, 2012, pp.321545~ (2012)
- Ahanya SN., "Meconium passage in utero : mechanisms, consequences, and management", Obstet Gynecol Surv, 60, pp.45~56 (2005)
- Hofmeyr GJ, "Amnioinfusion for meconiumstained liquor in labour", Cochrane Database Syst Rev, pp.CD000014~ (2010)
- Lauzon L, "Labour assessment programs to delay admission to labour wards", Cochrane Database Syst Rev, pp.CD000936~ (2001)
- Zhang X., "Variations in mortality and morbidity by gestational age among infants born at term", J Pediatr, 154, pp.358-62~362.e1 (2009)
- Fanaroff AA., "Meconium aspiration syndrome : historical aspects", J Perinatol, 28(Suppl 3), pp.S3~S7 (2008)
- Ross MG., "Meconium aspiration syndrome : more than intrapartum meconium", N Engl J Med, 353, pp.946~948 (2005)
- Whitfield JM., "Prevention of meconium aspiration syndrome : an update and the Baylor experience", Proc(Bayl Univ Med Cent), 22, pp.128~131 (2009)
- Osava RH., "Meconium-stained amniotic fluid and maternal and neonatal factors associated", Rev Saude Publica, 46, pp.1023~1029 (2012)
- Paz Y., "Variables associated with meconium aspiration syndrome in labors with thick meconium", Eur J Obstet Gynecol Reprod Biol, 94, pp.27~30 (2001)
- Khazardoost S., "Risk factors for meconium aspiration in meconium stained amniotic fluid", J Obstet Gynaecol, 27, pp.577~579 (2007)
- Xu H., "Risk factors for early and late onset of respiratory symptoms in babies born through meconium", Am J Perinatol, 27, pp.271~278 (2010)
- Balchin I., "Maternal and fetal characteristics associated with meconium-stained amniotic fluid", Obstet Gynecol, 117, pp.828~835 (2011)
- Karatekin G., "Risk factors for meconium aspiration syndrome", Int J Gynaecol Obstet, 65, pp.295~297 (1999)
- Dargaville PA., "The epidemiology of meconium aspiration syndrome : incidence, risk factors, therapies, and outcome", Pediatrics, 117, pp.1712~1721 (2006)
- Xu H., "Obstetric approaches to the prevention of meconium aspiration syndrome", J Perinatol, 28(Suppl 3), pp.S14~S18 (2008)
- Vivian-Taylor J., "Trends in obstetric practices and meconium aspiration syndrome : a population-based study", BJOG, 118, pp.1601~1607 (2011)
- Bhutani VK., "Developing a systems approach to prevent meconium aspiration syndrome: lessons learned from multinational studies", J Perinatol, 28(Suppl 3), pp.S30~S35 (2008)
- Hernandez C., "Prediction of the severity of meconium aspiration syndrome", Am J Obstet Gynecol, 169, pp.61~70 (1993)
- Wiswell TE., "Handling the meconium-stained infant", Semin Neonatol, 6, pp.225~231 (2001)
- Usta IM., "Risk factors for meconium aspiration syndrome", Obstet Gynecol, 86, pp.230~234 (1995)
- Ghidini A., "Severe meconium aspiration syndrome is not caused by aspiration of meconium", Am J Obstet Gynecol, 185, pp.931~938 (2001)
- Sunoo C., "Meconium aspiration syndrome without evidence of fetal distress in early labor before elective cesarean delivery", Obstet Gynecol, 73, pp.707~709 (1989)
- Spong CY., "Prophylactic amnioinfusion for meconium-stained amniotic fluid", Am J Obstet Gynecol, 171, pp.931~935 (1994)
- Turbeville DF., "In utero distal pulmonary meconium aspiration", South Med J, 72, pp.535~536 (1979)
- Brown BL., "Intrauterine meconium aspiration", Obstet Gynecol, 57, pp.26~29 (1981)
- Cleary GM., "Meconium-stained amniotic fluid and the meconium aspiration syndrome : an update", Pediatr Clin North Am, 45, pp.511~529 (1998)
- Wiswell TE., "Meconium staining and the meconium aspiration syndrome : unresolved issues", Pediatr Clin North Am, 40, pp.955~981 (1993)
- Yoder BA., "Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome", Obstet Gynecol, 99, pp.731~739 (2002)
- Yeomans ER., "Meconium in the amniotic fluid and fetal acid-base status", Obstet Gynecol, 73, pp.175~178 (1989)
- Carbonne B., "Fetal oxygen saturation measured by pulse oximetry during labour with clear or meconium-stained amniotic fluid. Eur J Obstet Gynecol Reprod Biol 72 Suppl", Eur J Obstet Gynecol Reprod Biol, 72(Suppl), pp.S51~S55 (1997)
- Blackwell SC., "Meconium aspiration syndrome in term neonates with normal acid-base status at delivery : is it different?", Am J Obstet Gynecol, 184, pp.1422~1425 (2001)
- Thureen PJ., "Fatal meconium aspiration in spite of appropriate perinatal airway management : pulmonary and placental evidence of prenatal disease", Am J Obstet Gynecol, 176, pp.967~975 (1997)
- Burgess AM., "Inflammation of the lungs, umbilical cord and placenta associated with meconium passage in utero : review of 123 autopsied cases", Pathol Res Pract, 192, pp.1121~1128 (1996)