From Meconium Staining to Respiratory Support: Clinical Spectrum and Early Neonatal Outcomes across Two Referral Centers

Abstract

Background: Meconium-stained amniotic fluid (MSAF) is associated with neonatal respiratory morbidity, including meconium aspiration syndrome (MAS). Objective: The objective of this study was to evaluate the clinical characteristics, spectrum of respiratory support required, and short-term outcomes among neonates born through MSAF in two referral centers. Materials and Methods: This prospective two-center cohort study included 72 neonates born through MSAF. Maternal, obstetric, and neonatal characteristics were recorded. Neonates were assessed for respiratory distress, MAS, need for oxygen, continuous positive airway pressure (CPAP), mechanical ventilation, complications, and in-hospital outcome. Results: MAS developed in 19/72 neonates (26.4%), while respiratory distress occurred in 26/72 (36.1%). Neonates with MAS had significantly lower Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) scores at 1 min (5.40 vs. 7.40) and 5 min (7.50 vs. 8.50; both P = 0.001). Among neonates with respiratory distress, 26.9% settled within 2 h, 30.8% received oxygen by hood, 26.9% required CPAP, and 15.4% required mechanical ventilation. Pneumothorax occurred in 4.2%, while persistent pulmonary hypertension, septicemia, hypoxic-ischemic encephalopathy, and shock each occurred in 2.8%. Two of 19 neonates with MAS died. Conclusion: MAS was common among MSAF-exposed neonates and was associated with lower APGAR scores and substantial respiratory morbidity.