Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

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

Abstract

Objective:

The purpose of this study was to evaluate the demographic and treatment characteristics of neonates (37 weeks' estimated gestational age) who were admitted to a neonatal intensive care unit (NICU) for a diagnosis of meconium aspiration syndrome (MAS) during the years 1997 to 2007. The goals in studying this group of neonates were to better estimate the magnitude of abnormal outcomes and to determine the proportion of these infants exposed to specific therapeutic interventions.

Study Design:

Retrospective review of an administrative de-identified data set.

Result:

A total of 415 772 neonates formed the starting data set and 162 075 (39%) were 37 weeks. Of the 162 075 term neonates, 7518 (1.8% of all neonates and 4.6% of term NICU admissions) had an admission diagnosis of MAS. In the 7518 neonates, the following outcomes were observed: 6124 (81.5%) were discharged home; 679 (9%) were acutely transferred to a higher level of intensive care; 416 (5.5%) were transferred to another clinical service within the hospital; 178 (2.4%) were transferred to another NICU for convalescent care and 88 (1.2%) died. There were 33 (0.4%) who did not have data on outcome at discharge. During the period between 2002 and 2005, acute transfer rates decreased (12.4 to 9%) and the reported rate for death remained relatively constant between 0.9 and 1.5%. There were 107 (1.4%) neonates who were treated (n=61) with, or transferred, for extracorporeal membrane oxygenation (ECMO) (n=46). Three of the sixty-one neonates (4.9%) who were treated with ECMO died.

Conclusion:

Term neonates who are admitted with a diagnosis of MAS continue to represent a high-risk population with significant morbidity, and they often require intensive therapies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2

Similar content being viewed by others

References

  1. Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H, Walsh WF et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109: 1081–1087.

    Article  Google Scholar 

  2. Gouyon JB, Ribakovsky C, Ferdynus C, Quantin C, Sagot P, Gouyon B . Severe respiratory disorders in term neonates. Paediatr Perinat Epidemiol 2008; 22: 22–30.

    PubMed  Google Scholar 

  3. Djemal N, Ben AH, Masmoudi K, Rguaieg R, Trigui L, Ben HA et al. Pulmonary function in children after neonatal meconium aspiration syndrome. Arch Pediatr 2008; 15 (2): 105–110.

    Article  CAS  Google Scholar 

  4. Vohr BR, Wright LL, Dusick AM, Perritt R, Poole WK, Tyson JE et al. Center differences and outcomes of extremely low birth weight infants. Pediatrics 2004; 113: 781–789.

    Article  Google Scholar 

  5. Horbar JD, Badger GJ, Carpenter JH, Fanaroff AA, Kilpatrick S, LaCorte M et al. Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 2002; 110: 143–151.

    Article  Google Scholar 

  6. Hack M, Wilson-Costello D, Friedman H, Taylor GH, Schluchter M, Fanaroff AA . Neurodevelopment and predictors of outcomes of children with birth weights of less than 1000 g: 1992–1995. Arch Pediatr Adolesc Med 2000; 154: 725–731.

    Article  CAS  Google Scholar 

  7. Vohr BR, Wright LL, Dusick AM, Mele L, Verter J, Steichen JJ et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics 2000; 105: 1216–1226.

    Article  CAS  Google Scholar 

  8. Bennett CC, Johnson A, Field DJ . A comparison of clinical variables that predict adverse outcome in term infants with severe respiratory failure randomised to a policy of extracorporeal membrane oxygenation or to conventional neonatal intensive care. J Perinat Med 2002; 30: 225–230.

    Article  Google Scholar 

  9. Clark RH, Huckaby JL, Kueser TJ, Walker MW, Southgate WM, Perez JA et al. Low-dose nitric oxide therapy for persistent pulmonary hypertension: 1-year follow-up. J Perinatol 2003; 23: 300–303.

    Article  CAS  Google Scholar 

  10. Escobar GJ, Clark RH, Greene JD . Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol 2006; 30: 28–33.

    Article  Google Scholar 

  11. Clark RH . The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol 2005; 25: 251–257.

    Article  Google Scholar 

  12. UK Collaborative ECMO Trail Group. The collaborative UK ECMO (Extracorporeal Membrane Oxygenation) trial: follow-up to 1 year of age. Pediatrics 1998; 101: E1.

    Article  Google Scholar 

  13. Angus DC, Linde-Zwirble WT, Clermont G, Griffin MF, Clark RH . Epidemiology of neonatal respiratory failure in the United States: projections from California and New York. Am J Respir Crit Care Med 2001; 164: 1154–1160.

    Article  CAS  Google Scholar 

  14. Finer NN, Barrington KJ . Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev 2006; 18 (4): CD000399. Review. PMID: 17054129

    Google Scholar 

  15. Cleary GM, Wiswell TE . Meconium-stained amniotic fluid and the meconium aspiration syndrome An update Pediatr Clin North Am 1998; 45: 511–529.

    Article  CAS  Google Scholar 

  16. Abrams ME, Meredith KS, Kinnard P, Clark RH . Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 2007; 120: 84–89.

    Article  Google Scholar 

  17. Cohen-Wolkowiez M, Smith PB, Mangum B, Steinbach WJ, Alexander BD, Cotten CM et al. Neonatal Candida meningitis: significance of cerebrospinal fluid parameters and blood cultures. J Perinatol 2007; 27: 97–100.

    Article  CAS  Google Scholar 

  18. Laughon M, Bose C, Clark R . Treatment strategies to prevent or close a patent ductus arteriosus in preterm infants and outcomes. J Perinatol 2007; 27: 164–170.

    Article  CAS  Google Scholar 

  19. Roy BJ, Rycus P, Conrad SA, Clark RH . The changing demographics of neonatal extracorporeal membrane oxygenation patients reported to the Extracorporeal Life Support Organization (ELSO) Registry. Pediatrics 2000; 106: 1334–1338.

    Article  CAS  Google Scholar 

  20. Boedy RF, Howell CG, Kanto WP . Hidden mortality rate associated with extracorporeal membrane oxygenation. J Pediatr 1990; 117: 462–464.

    Article  CAS  Google Scholar 

  21. Clark RH, Bloom BT, Spitzer AR, Gerstmann DR . Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics 2006; 117: 67–74.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to R H Clark.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, B., Clark, R., Powers, R. et al. 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, 497–503 (2009). https://doi.org/10.1038/jp.2008.241

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2008.241

This article is cited by

Search

Quick links