Clinical Characteristics of Meconium Aspiration Syndrome according to Ventilator Care

Ryoung-Kyoung Lim; Mi-hye Bae; Ah-Young Kim; Young-Mi Han; Kyung-Hee Park; Shin-Yun Byun

doi:10.14734/kjp.2015.26.2.121

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

Original Article

Korean J Perinatol 2015;26(2):121-127.

Published online: 20 June 2015

DOI: https://doi.org/10.14734/kjp.2015.26.2.121

Clinical Characteristics of Meconium Aspiration Syndrome according to Ventilator Care

Ryoung-Kyoung Lim, M.D., Mi-hye Bae, M.D., Ah-Young Kim, M.D., Young-Mi Han, M.D., Kyung-Hee Park, M.D., Shin-Yun Byun, M.D.

Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea

Correspondence to: Shin-Yun Byun, M.D. Department of Pediatrics, Pusan National University Children's Hospital, 20 Geumo-ro, Mulgeum-eup, Yangsan 626-770, Korea Tel: +82-55-360-2180, Fax: +82-55-360-2181 E-mail: byun410@hanmail.net

Received 2 April 2015 Revised 10 June 2015 Accepted 11 June 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Meconium aspiration syndrome, Ventilator care, Risk factors

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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