Clinico-Investigative Profile of Newborns with Meconium Stained Liquor Delivered at a Rural Tertiary Care Hospital (Code-T0244)

Background: Meconium aspiration syndrome (MAS) is a critical condition seen in neonates who inhale meconium-stained amniotic fluid (MSAF), leading to respiratory distress. The presence of MSAF is often associated with fetal distress and is an established risk factor for poor fetal outcomes. This study focuses on the clinico-investigative profile and outcomes of newborns born with MSAF, specifically comparing vigorous and non-vigorous neonates.

Aim: To assess the clinico-investigative profile and outcomes of vigorous and non-vigorous newborns delivered with meconium-stained liquor.

Objectives:

1. To examine the clinico-investigative profile of vigorous and non-vigorous newborns delivered with meconium-stained liquor.
2. To investigate the correlation between cord blood gas parameters and the condition of the newborn (vigorous vs non-vigorous).
3. To evaluate the neonatal outcomes in cases of MSAF.

Design: Descriptive longitudinal study

Study Period: June 2022 - June 2024

Setting: Department of Pediatrics, Dr. Balasaheb Vikhe Patil Rural Medical College, Loni

Methodology: This study involved neonates born with MSAF, with detailed documentation of clinical histories, examinations, investigations, and treatments on a pre-designed proforma. Statistical analysis was conducted using SPSS 16 software.

Results: Out of 160 neonates, 55 (34.4%) required NICU admission, while the rest were monitored on the mother’s side. Thick meconium was found in 25 (15.6%) cases, while 135 (84.4%) had thin meconium. Non-reassuring NST was observed in 35.3% of cases, with 20 of these having thick meconium. The most common maternal risk factors included hypertension (29%), oligohydramnios (9%), and premature rupture of membranes (4%). A majority (92.5%) of neonates had a birth weight >2.5 kg, and 80% were vigorous at birth. Non-vigorous neonates (20%) predominantly had thick meconium (85%). More intensive interventions, including positive pressure ventilation and intubation, were required for neonates with thick MSAF. Neonates with thin MSAF generally required less respiratory support, with 50% needing no oxygen supplementation. Complications like perinatal depression, sepsis, and neonatal seizures were more common in thick MSAF cases. The mortality rate was 5%, all involving thick meconium, with the majority of these being non-vigorous and having abnormal cord pH levels.

Conclusion: Meconium aspiration syndrome is a major cause of morbidity and mortality in neonates, particularly in cases with thick meconium. Both primigravida and multigravida mothers are at risk. Non-reassuring NST serves as a useful predictor of poor fetal outcomes. Prompt administration of oxygen and surfactant improves neonatal survival. This study highlights the importance of early intervention and careful monitoring in managing neonates with MSAF.

Keywords: Meconium aspiration syndrome, Meconium-stained liquor, Neonatal outcomes, Non-vigorous newborns, Respiratory distress, Perinatal depression.