Journal List > Korean J Perinatol > v.26(2) > 1013745

Lim, Bae, Kim, Han, Park, and Byun: Clinical Characteristics of Meconium Aspiration Syndrome according to Ventilator Care

Abstract

Purpose

Meconium aspiration syndrome is an important cause of neonatal morbidity and mortality, and sometimes patients need mechanical ventilator therapy. The aim of this study was to identify the risk factors which required mechanical ventilation.

Methods

We retrospectively analyzed 44 infants diagnosed as meconium aspiration syndrome from January 2009 to December 2013. We divided into 2 groups (ventilator group and oxygen therapy group) and analyzed the clinical characteristics, vital signs, laboratory findings and clinical courses.

Results

Ventilator group and oxygen therapy group included each 22 infants, and there were no significant differences in clinical characteristics between two groups. Time to transfer and time to start oxygen therapy were longer in ventilator group but not statistical difference. Initial mean blood pressure and pH were significantly lower in ventilator group than in oxygen therapy group (P=0.026, P=0.003). Ventilator group had longer treatment period and worse prognosis than oxygen therapy group.

Conclusion

If the infants with meconium aspiration and respiratory distress represent low pH and hypotension, we have to pay close attention to early oxygen supplementation and proper treatment to prevent poor clinical course.

References

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Table 1.
Clinical Characteristics and Initial Vital Signs of Patients
  Ventilator group (n=22) Nasal O2 group (n=22) P-value
Gestational age (weeks) 39+6 39+6 0.815
Birth weight (g) 3187.27±501.28 3243.64±500.13 0.711
IUGR, n(%) 2(9.1) 1(4.5) 1.000
Male gender, n(%) 8(36.4) 12(54.5) 0.226
Apgar score      
1 min 5.41±1.87 6.09±2.09 0.261
5 min 7.55±1.22 8.00±1.57 0.291
Delivery, n(%)      
NSVD 12(54.5) 12(54.5) 0.616
C/S without labor 3(13.6) 1(4.5)  
C/S with labor 7(31.8) 9(40.9)  
Inborn, n(%) 4(18.2) 8(36.4) 0.176
Time to transfer (hours) 7.73±17.24 3.86±6.42 0.333
Time to start oxygen therapy (hrs) 4.30±16.26 2.77±5.85 0.683
Body temperature (℃) 36.66±0.53 36.62±0.41 0.801
Systolic blood pressure (mmHg) 62.77±10.69 67.50±8.16 0.107
Diastolic blood pressure (mmHg) 37.73±9.56 44.64±9.55 0.021
Mean blood pressure (mmHg) 46.57±8.69 52.32±8.73 0.026

Abbreviation: IUGR, intrauterine growth retardation

Fisher's exact test

Table 2.
Initial Laboratory Finding of Patients
  Ventilator group (n=22) Nasal O2 group (n=22) P-value
pH 7.28±0.09 7.36±0.08 0.003
PaCO2 (mmHg) 34.58±11.17 29.70±7.83 0.101
PaO2 (mmHg) 83.06±37.83 99.91±65.17 0.301
HCO3 (mM) 16.46±5.22 16.82±4.23 0.806
WBC (/μL) 18,065.91±9,812.80 17,050.45±5,710.90 0.677
Hemoglobin (g/dL) 15.08±3.27 16.53±2.48 0.105
Platelet (103/μL) 211.73±71.38 242.09±45.74 0.102
LDH (IU/L) 1550.5±885.35 1750.77±1661.98 0.621
CRP (mg/dL) 0.48±1.50 0.44±0.85 0.918
Glucose (mg/dL) 102.27±62.84 78.86±29.99 0.122
Na (mmol/L) 136.86±3.00 135.68±9.76 0.256
K (mmol/L) 4.09±0.58 4.40±0.41 0.049
Table 3.
Clinical Course of Patients
  Ventilator group (n=22) Nasal O2 group (n=22) P-value
Duration of oxygen (days) 7.82±6.13 4.23±3.37 0.022
iNO, n (%) 7(31.8) 0(0) 0.009
Duration of iNO (days) 2.00±4.30 0 0.035
Duration of inotropics (days) 3.64±4.72 0.14±0.64 0.001
Hospital duration (days) 15.86±9.23 10.30±4.70 0.009
PPHN, n(%) 9 (40.9) 1(4.5) 0.004
Neurologic complication (n) 2 0 0.488
Death (n) 2 0 0.488

Abbreviation: PPHN, persistent pulmonary hypertension of the newborn

Fisher's exact test

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