The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years / 中国当代儿科杂志

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP®) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP® guidelines over the past 60 years.

Síndrome de aspiración meconial: revisión de la fisiopatología y estrategias de manejo / Meconium aspiration syndrome: review of the pathophysiology and management strategies

El síndrome de aspiración meconial, es una condición clínica caracterizada por insuficiencia respiratoria que ocurre en neonatos nacidos a través de líquido amniótico teñido de meconio, y que puede presentarse como una enfermedad grave con riesgo vital. Su incidencia ha disminuido gracias a mejores prácticas obstétricas y atención perinatal y se ha observado una mejoría en la sobrevida, gracias a mejores prácticas en la UCI neonatal. Sin embargo, el abordaje más adecuado sigue siendo un tema de debate, dado que hasta el momento se basa sólo en medidas de soporte, sin que existan medidas que actúen sobre los mecanismos de daño. Por otro lado, la morbilidad a largo plazo entre los sobrevivientes sigue siendo una preocupación importante. Esta revisión ofrece una visión general actualizada de la epidemiología, la fisiopatología, el diagnóstico, el manejo terapéutico, la prevención y el pronóstico de los pacientes que presentan este cuadro.

Meconium aspiration syndrome is a clinical condition characterized by respiratory failure that occurs in neonates born through meconium-stained amniotic fluid and can present as a serious life-threatening disease. Its incidence has decreased thanks to better obstetric practices and perinatal care, and an improvement in survival has been observed, thanks to better practices in the neonatal ICU. However, the most appropriate approach is still a matter of debate, given that so far it is based only on support measures, without any measures that act on the damage mechanisms. On the other hand, long-term morbidity among survivors remains a major concern. This review offers an updated overview of the epidemiology, pathophysiology, diagnosis, therapeutic management, prevention, and prognosis of patients with this condition.

Clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for severe MAS in neonates with meconium-stained amniotic fluid / 中国当代儿科杂志

OBJECTIVES@#To study the clinical features of severe meconium aspiration syndrome (MAS) and early predicting factors for the development of severe MAS in neonates with meconium-stained amniotic fluid (MSAF).@*METHODS@#A total of 295 neonates who were hospitalized due to Ⅲ° MSAF from January 2018 to December 2019 were enrolled as subjects. The neonates were classified to a non-MAS group (n=199), a mild/moderate MAS group (n=77), and a severe MAS group (n=19). A retrospective analysis was performed for general clinical data, blood gas parameters, infection indicators, and perinatal clinical data of the mother. The respiratory support regimens after birth were compared among the three groups. The receiver operating characteristic (ROC) curve and multivariate logistic regression analysis were used to investigate predicting factors for the development of severe MAS in neonates with MSAF.@*RESULTS@#Among the 295 neonates with MSAF, 32.5% (96/295) experienced MAS, among whom 20% (19/96) had severe MAS. Compared with the mild/moderate MAS group and the non-MAS group, the severe MAS group had a significantly lower 5-minute Apgar score (P<0.05) and a significantly higher blood lactate level in the umbilical artery (P<0.05). Compared with the non-MAS group, the severe MAS group had a significantly higher level of interleukin-6 (IL-6) in peripheral blood at 1 hour after birth (P<0.017). In the severe MAS group, 79% (15/19) of the neonates were born inactive, among whom 13 underwent meconium suctioning, and 100% of the neonates started to receive mechanical ventilation within 24 hours. Peripheral blood IL-6 >39.02 pg/mL and white blood cell count (WBC) >30.345×109/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (P<0.05).@*CONCLUSIONS@#Meconium suctioning cannot completely prevent the onset of severe MAS in neonates with MSAF. The neonates with severe MAS may develop severe respiratory distress and require mechanical ventilation early after birth. Close monitoring of blood lactate in the umbilical artery and peripheral blood IL-6 and WBC at 1 hour after birth may help with early prediction of the development and severity of MAS.

A retrospective cohort study of tracheal intubation for meconium suction in nonvigorous neonates / 中国当代儿科杂志

OBJECTIVES@#To study the feasibility of tracheal intubation for meconium suction immediately after birth of nonvigorous neonates born through meconium-stained amniotic fluid (MSAF).@*METHODS@#A retrospective cohort study was performed on nonvigorous neonates born through MSAF who were admitted to the Department of Neonatology, Zhecheng People's Hospital. The neonates without meconium suction who were admitted from July 1, 2017 to June 30, 2018 were enrolled as the control group. The neonates who underwent meconium suction from July 1, 2018 to June 30, 2019 were enrolled as the suction group. The two groups were compared in terms of the mortality rate and the incidence rates of neonatal meconium aspiration syndrome (MAS), persistent pulmonary hypertension of the newborn, pneumothorax, and pulmonary hemorrhage.@*RESULTS@#There were 80 neonates in the control group and 71 in the suction group. There were no significant differences between the two groups in the incidence rates of MAS (11% vs 7%), persistent pulmonary hypertension of the newborn (5% vs 4%), pneumothorax (3% vs 1%), and death (0% vs 1%). Compared with the control group, the suction group had a significantly lower proportion of neonates requiring oxygen inhalation (16% vs 33%, P<0.05), noninvasive respiratory support (25% vs 41%, P<0.05) or mechanical ventilation (10% vs 23%, P<0.05) and significantly shorter duration of noninvasive ventilation [(58±24) hours vs (83±41) hours, P<0.05] and length of hospital stay [6(4, 8) days vs 7(5, 10) days, P<0.05].@*CONCLUSIONS@#Although tracheal intubation for meconium suction immediately after birth may shorten the duration of respiratory support for mild respiratory problems, it cannot reduce the incidence rate of MAS, mortality rate, or the incidence rate of serious complications in nonvigorous infants born through MSAF.

Predictors of chest drainage of pneumothorax in neonates

This is a retrospective, single-center observational study to explore the predictors of chest drainage for neonatal pneumothorax. A total of 183 neonates (age ≤28 days) who presented to the Children's Hospital of Soochow University between January 1, 2015 and December 31, 2018 for pneumothorax or developed pneumothorax during a hospital stay were included. Demographic data, clinical presentation, and imaging characteristics of neonatal pneumothorax were collected and analyzed. We used univariate and multivariate logistic regression analyses to determine significant predictors of chest drainage of pneumothorax in neonates. Pneumothorax occurred within 24 h after birth in 131 (71.6%) cases, between 24 and 48 h after birth in 41 (22.4%) cases, and 48 h after birth in 11 (6.0%) cases. Univariate and multivariate logistic regression analyses revealed that lung collapse ≥1/3 on initial chest X-ray (OR 4.99, 95%CI 2.25-11.07), chest retractions (OR 8.12, 95%CI 2.88-22.89), cyanosis (OR 2.25, 95%CI 1.08-4.66), and frothing from mouth (OR 2.49, 95%CI 1.12-5.49) (P<0.05 for all) were significant predictors of the need for chest drainage due to pneumothorax. In conclusion, the thorough evaluation of the above predictive factors can guide treatment and improve patient outcome.

A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China / 中国当代儿科杂志

OBJECTIVE@#To investigate the clinical features and outcome of neonatal acute respiratory distress syndrome (ARDS) in southwest Hubei, China.@*METHODS@#According to the Montreux definition of neonatal ARDS, a retrospective clinical epidemiological investigation was performed on the medical data of neonates with ARDS who were admitted to Department of Neonatology/Pediatrics in 17 level 2 or level 3 hospitals in southwest Hubei from January to December, 2017.@*RESULTS@#A total of 7 150 neonates were admitted to the 17 hospitals in southwest Hubei during 2017 and 66 (0.92%) were diagnosed with ARDS. Among the 66 neonates with ARDS, 23 (35%) had mild ARDS, 28 (42%) had moderate ARDS, and 15 (23%) had severe ARDS. The main primary diseases for neonatal ARDS were perinatal asphyxia in 23 neonates (35%), pneumonia in 18 neonates (27%), sepsis in 12 neonates (18%), and meconium aspiration syndrome in 10 neonates (15%). Among the 66 neonates with ARDS, 10 neonates (15%) were born to the mothers with an age of ≥35 years, 30 neonates (45%) suffered from intrauterine distress, 32 neonates (49%) had a 1-minute Apgar score of 0 to 7 points, 24 neonates (36%) had abnormal fetal heart monitoring results, and 21 neonates (32%) experienced meconium staining of amniotic fluid. Intraventricular hemorrhage was the most common comorbidity (12 neonates), followed by neonatal shock (9 neonates) and patent ductus arteriosus (8 neonates). All 66 neonates with ARDS were treated with mechanical ventilation in addition to the treatment for primary diseases. Among the 66 neonates with ARDS, 10 died, with a mortality rate of 15% (10/66), and 56 neonates were improved or cured, with a survival rate of 85% (56/66).@*CONCLUSIONS@#Neonatal ARDS in southwest Hubei is mostly mild or moderate. Perinatal asphyxia and infection may be the main causes of neonatal ARDS in this area. Intraventricular hemorrhage is the most common comorbidity. Neonates with ARDS tend to have a high survival rate after multimodality treatment.

Empirical Antibiotics in Non-Ventilated Cases of Meconium Aspiration Syndrome

PURPOSE: Meconium aspiration is assumed to be a risk factor for bacterial infection, and patients with meconium aspiration syndrome (MAS) are commonly treated with empiric antibiotics in clinical settings. However, little is known about the effectiveness of the empirical antibiotics treatment. Here, we compared the short-term clinical outcomes associated with empirical antibiotics treatment in non-ventilated cases of MAS. METHODS: A retrospective study was conducted on infants admitted with non-ventilated cases of MAS from March 2008 to September 2016. The infants enrolled in the study were divided into two groups based on the antibiotics treatment, and their clinical outcomes were compared. The incidence of sepsis during the hospitalization period and the incidence of delayed sepsis up to 3 months were evaluated. The effects of empirical antibiotic use on respiratory symptoms were evaluated, and the complications were compared. RESULTS: A total of 109 infants were evaluated, of which 61 (56.0%) received antibiotics and 48 (44.0%) did not receive antibiotics. No differences in clinical characteristics were noted between the two groups. However, the empirical antibiotics group showed a significantly higher mean of respiratory rates, C-reactive protein levels, and positive rates, as well as a significantly longer hospitalization period. In clinical outcomes, there were no differences in sepsis rates or respiratory support duration. Furthermore, there were no differences in complications. CONCLUSION: The empirical use of antibiotics did not affect the clinical outcomes in cases of non-ventilated MAS. The role of empirical antibiotics in these infants may need to be reevaluated.

Clinical features and prognosis of meconium aspiration syndrome complicated by pulmonary hemorrhage in neonates / 中国当代儿科杂志

OBJECTIVE@#To study the clinical features and prognosis of meconium aspiration syndrome (MAS) complicated by neonatal pulmonary hemorrhage (NPH) in neonates.@*METHODS@#A retrospective analysis was performed for the clinical data of 45 neonates with MAS complicated by NPH who were admitted to the hospital from December 2015 to December 2018 (observation group). Ninety neonates with MAS who were hospitalized during the same period of time and had no pulmonary hemorrhage were enrolled as the control group. The two groups were compared in terms of clinical features and prognosis.@*RESULTS@#The observation group had a significantly lower 1-minute Apgar score after birth than the control group (P<0.05). Compared with the control group, the observation group had significantly higher incidence rates of persistent pulmonary hypertension of the newborn, air leak syndrome and shock and a higher rate of use of pulmonary surfactant (P<0.05), as well as higher levels of C-reactive protein and oxygen index (OI) (P<0.01). In the early diagnosis of NPH, OI had a sensitivity of 80.0%, a specificity of 96.7%, and an area under the receiver operating characteristic curve of 0.959 (95% confidence interval: 0.929-0.988, P<0.001) at the cut-off value of 10.05. For the children who were cured and discharged, the observation group had significantly longer duration of ventilation, duration of oxygen inhalation and length of hospital stay than the control group (P<0.05).@*CONCLUSIONS@#Neonates with MAS complicated by NPH tend to have a longer duration of ventilation and higher incidence rates of air leak syndrome and shock. OI may be used as an index for the early diagnosis of MAS complicated by NPH.

Tinción del líquido amniótico por meconio y resultante neonatal en embarazos de bajo riesgo / Amniotic fluid staining by meconium and neonatal outcome in low risk pregnancies

El propósito del estudio fue establecer la asociación entre la tinción del líquido amniótico por meconio y la resultante neonatal en embarazos de bajo riesgo. Se realizó un estudio prospectivo de cohortes complementado por revisión retrospectiva en el Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Se evaluaron las variables de atención hospitalaria neonatal, puntaje de Apgar y tasa de hospitalización luego de 30 días del nacimiento. Se incluyeron 389 casos de líquido amniótico con meconio espeso (grupo A), 276 casos de líquido amniótico con meconio claro (grupo B) y 103 casos con líquido amniótico con meconio terminal. El grupo de control estaba compuesto por 621 neonatos con líquido amniótico claro (grupo D). Los neonatos de los tres grupos de estudio presentaron puntajes de Apgar al minuto y a los 5 minutos significativamente menores comparado con el grupo D (p < 0,001). La atención pediátrica en la sala de parto fue en forma significativamente más frecuente en el grupo A (p < 0,001). La tasa de consulta pediátrica luego del parto fue del 18,2 % en los neonatos del grupo A comparado con 9,3 % en los neonatos del grupo D (p < 0.001). Se concluye que la presencia y tipo de líquido amniótico teñido de meconio puede predecir el aumento proporcional del uso de recursos hospitalarios, expresados en forma de asistencia pediátrica y medidas de resucitación empleada.

The purpose of the study was to establish the association between amniotic fluid staining by meconium and neonatal outcome in low risk pregnancies. A prospective cohort study was carried out, complemented by a retrospective review at Hospital Central Dr. Urquinaona, Maracaibo, Venezuela. Neonatal hospital care, Apgar score and hospitalization rate after 30 days of birth were evaluated. We included 389 cases of amniotic fluid with thick meconium (group A), 276 cases of amniotic fluid with clear meconium (group B) and 103 cases with amniotic fluid with terminal meconium. The control group consisted of 621 neonates with clear amniotic fluid (group D). The neonates of the three study groups presented Apgar scores at minute and 5 minutes significantly lower compared to group D (p <0.001). Pediatric care in the delivery room was significantly more frequent in group A (p <0.001). The pediatric consultation rate after delivery was 18,2 % in the neonates of group A compared with 9,3 % in the neonates of group D (p <0.001). It is concluded that the presence and type of amniotic fluid stained with meconium can predict the proportional increase in the use of hospital resources, expressed in the form of pediatric care and resuscitation measures used.

Effects of hypothermia on lung inflammation in a rat model of meconium aspiration syndrome

Abstract Purpose: To evaluate the effects of hypothermia treatment on meconium-induced inflammation. Methods: Fifteen rats were instilled with human meconium (MEC, 1.5 mL/kg, 65 mg/mL) intratracheally and ventilated for 3 hours. Eight rats that were ventilated and not instilled with meconium served as a sham group. In MEC-hypothermia group, the body temperature was lowered to 33±0.5°C. Analysis of the blood gases, interleukin (IL)-1β, IL-6, IL-8, and tumor necrosis factor (TNF)-α in bronchoalveolar lavage (BAL) fluid samples, and histological analyses of the lungs were performed. Results: The BAL fluid TNF-α, IL-1β, IL-6 and IL-8 concentrations were significantly higher in the MEC-hypothermia group than in the MEC-normothermia (p < 0.001, p < 0.001, p = 0.001, p < 0.001, respectively) and sham-controlled groups (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). Conclusion: Meconium-induced inflammatory cytokine production is affected by the body temperature control.

Aplicación de escalas de alerta temprana en recién nacidos a término y prematuros tardíos. Estudio epidemiológico, transversal descriptivo documental basado en las historias clínicas de un grupo de neonatos / Application of early warning scales in newborns at term and late prematures. Epidemiological study, descriptive transversal documentary based on the clinical stories of a group of neonatos

Objetivo general: Aplicar escalas de alerta temprana en recién nacidos a término y prematuros tardíos. Objetivos específicos: Identificar los factores de riesgo prenatales que se encuentran en el grupo de pacientes estudiados; Recomendar el uso de la escala que detecte mejor las enfermedades y las complicaciones de los pacientes en riesgo. Población: Pacientes a término y prematuros tardíos, mayores de 35 semanas con factores de riesgo, nacidos en el HGONA. Materiales y Métodos: Se analizó la capacidad de cada escala para detectar patología según los puntajes obtenidos y luego se comparó entre escalas para analizar que escala obtuvo la mejor aproximación al número de pacientes enfermos. Resultados: Se encontró que las escalas NEWTT y NEW tuvieron una sensibilidad de 100% para síndrome adaptativo pulmonar y enfermedad de membrana hialina, NTS tuvo menor sensibilidad (71,4%) para esta patología. Para hipoglucemia la escala NEW tuvo una sensibilidad del 100%, en comparación de NEWTT y NTS que no la detectaron. En sepsis temprana la sensibilidad fue igual para NEW y NEWTT que obtuvieron puntaje de 2 y 3, NTS no la alertó. Para aspiración de meconio las tres escalas reportaron un puntaje bajo que debería analizarse dentro del contexto del inicio de la patología

Objective: Apply early warning scales in term newborns and late preterm infants. Specific objectives: Identify the prenatal risk factors found in the group of patients studied; To recommend the use of the scale that best detects the diseases and complications of patients at risk. Population: Term and late preterm patients, older than 35 weeks with risk factors, born in the HGONA. Material and Methods: The ability of each scale to detect pathology according to the scores obtained was analyzed and then it was compared between scales to analyze which scale obtained the best approximation to the number of sick patients. Results: It was found that the NEWTT and NEW scales had a sensitivity of 100% for pulmonary adaptive syndrome and hyaline membrane disease, NTS had lower sensitivity (71.4%) for this pathology. For hypoglycemia, the NEW scale had a sensitivity of 100%, compared to NEWTT and NTS that did not detect it. In early sepsis the sensitivity was the same for NEW and NEWTT who scored 2 and 3, NTS did not alert it. For meconium aspiration syndrome, all three scales reported a low score that should be analyzed within the context of the onset of the pathology

Mechanical Ventilation of Neonates at the University Hospital of the West Indies 1987-2015 / Ventilación Mecánica de Neonatos en el Hospital Universitario de West Indies 1987-2015

ABSTRACT Aim: To compare present trends in utilization of the neonatal intensive care unit (NICU) with trends seen during the period when neonates were ventilated in the main intensive care unit of the University Hospital of the West Indies. Methods: Data from previously published studies on outcome of neonates ventilated at the main intensive care unit 1987-2001, the neonatal intensive care unit 2002-2004 and the annual perinatal statistics (2006-2010, 2015) were reviewed to detect trends in mechanical ventilation, utilization and outcome. Descriptive analyses were performed. Results: The number of neonates mechanically ventilated per thousand admissions increased from 10/1000 in the 1990s to 73/1000 in 2015. Percentage mortality for ventilated neonates increased from 51% between 1987-1991 to 62 % in 2015. The proportion of extremely low birthweight infants (< 1000 g) mechanically ventilated increased from 29% in 1987-1991 to 50% in 2015. The percentage mortality for extremely low birthweight infants increased from 17.5% in 1987-1991 to 40.6% in 2015. The percentage mortality for all other birthweight categories decreased over time. Respiratory distress syndrome remains the major reason for neonates requiring mechanical ventilation. Fifty per cent of neonates < 1500 g ventilated for respiratory distress syndrome received surfactant replacement therapy. Conclusion: Access to mechanical ventilation by neonates has increased tremendously at the University Hospital of the West Indies. The present challenge, however, is decreasing mortality in these neonates who access this technology.

RESUMEN Objetivo: Comparar las tendencias actuales en la utilización de la Unidad de Cuidados Intensivos Neonatales (UCIN) con las tendencias observadas durante el período en que los neonatos eran ventilados en la Unidad Principal de Cuidados Intensivos del Hospital Universitario de West Indies. Métodos: Se revisaron los datos de estudios publicados anteriormente sobre el resultado clínico de los neonatos ventilados en la Unidad Principal de Cuidados Intensivos en 1987-2001, La Unidad de Cuidados Intensivos Neonatales en 2002-2004 y las y las Esta-dísticas Perinatales Anuales (2006-2010, 2015) con el propósito de detectar las tendencias en la utilización y los resultados de la ventilación mecánica. Se realizaron análisis descriptivos. Resultados: El número de neonatos ventilados mecánicamente por cada mil ingresos aumentó de 10/1000 en la década de 1990 a 73/1000 en 2015. El porcentaje de mortalidad de neonatos ventilados aumentó de 51% entre 1987-1991 a 62% en 2015. La proporción de neonatos de peso extremadamente bajo al nacer (< 1000 g) ventilados mecánicamente aumentó de 29% en 1987-1991 a 50% en 2015. El porcentaje de mortalidad de recién nacidos de peso extremadamente bajo al nacer aumentó de 17.5% en 1987-1991 a 40.6% en 2015. La mortalidad porcentual para todas las otras categorías de peso al nacer disminuyó con el tiempo. El síndrome de dificultad respiratoria sigue siendo la razón principal por la que los neonatos requieren ventilación mecánica. El cincuenta por ciento de los neonatos < 1500 g ventilados por el síndrome de dificultad respiratoria recibió terapia de reemplazo de surfactantes. Conclusión: El acceso a la ventilación mecánica por los neonatos ha aumentado enormemente en el Hospital Universitario de West Indies. No obstante, el reto actual es disminuir la mortalidad de los neonatos que acceden a esta tecnología.

Neonatal and Maternal Clinical Characteristics of Late Preterm Births: Single Center Data

PURPOSE: Recently, the number of late preterm infants are increasing, and they are prone to have many clinical problems. The purpose of this study is to emphasize the importance of perinatal care for the late preterm infants and their mothers. METHODS: Total admitted numbers of late preterm infants were 547 (from 464 mothers) and of term infants were 1,514 (from 1,470 mothers) in NICU, at Chonnam National University Hospital January 2014~December 2015. Maternal and neonatal mortality rate were calculated in the total admitted numbers. Exclusion criteria were death or transfer during admission, congenital anomaly, and etc. The enrolled numbers of late preterm infants were 493 (from 418 mothers) and of term infants were 1,167 (from 1,123 mothers). Retrospective chart review was conducted. In mothers, demographics, underlying illness, and obstetric complication, and in newborns, demographics, hospital days and morbidity were compared between late preterm group and term group. RESULTS: Maternal mortality rate was not different. However, neonatal mortality rate was higher in late preterm infants. In mothers of late preterm group, there was no difference in demographic characteristics, but the rates of autoimmune disease and obstetric complication were higher. In infants of late preterm group, body size was smaller, artificial conception and C-section rate were higher, and one and five-minute Apgar scores were lower, and hospital duration was longer. And the incidence of respiratory distress, transient tachypena of newborn, intraventricular hemorrhage and metabolic abnormalities were higher, but the incidence of meconium aspiration syndrome was lower compare to the term infant group. CONCLUSIONS: Maternal mortality was not different. However, neonatal mortality was higher in late preterm infants. In late preterm group, the mothers had higher rate of autoimmune disease and obstetric complication, and the infants had higher morbidity compare to the term group. When the obstetrician decides on delivery time in high risk pregnancy, maternal medical condition and neonatal outcome should be considered.

Application of humidified high-flow nasal cannula in neonates with meconium aspiration syndrome and pulmonary hypertension after extubation / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical value of humidified high-flow nasal cannula (HHFNC) as a respiratory support after extubation by comparing it with nasal continuous positive airway pressure (NCPAP) in neonates with meconium aspiration syndrome (MAS) and persistent pulmonary hypertension of the newborn (PPHN).</p><p><b>METHODS</b>A total of 78 neonates with MAS and PPHN were randomly administered with HHFNC or NCPAP immediately after extubation. The following indices were compared between the two groups: blood gas parameters, duration of noninvasive ventilation, rate of extubation failure, and incidence of complications, such as nasal damage, abdominal distension, and intraventricular hemorrhage.</p><p><b>RESULTS</b>There were no significant differences in the rate of extubation failure, PaO, PCO, and PaO/FiOratio at one hour after NCPAP or HHFNC, duration of noninvasive ventilation, time to full enteral feeding, length of hospital stay, and incidence of intraventricular hemorrhage between the two groups (P>0.05). The HHFNC group had significantly lower incidence of nasal damage (5.0% vs 31.6%; P<0.05) and incidence of abdominal distension (7.5% vs 34.2%; P<0.05) than the NCPAP group.</p><p><b>CONCLUSIONS</b>Both NCPAP and HHFNC can be used as the sequential therapy for neonates with MSA and PPHN after extubation, and they both have a definite effect. As a new strategy of respiratory support, HHFNC is better tolerated, and has fewer side effects than NCPAP.</p>

Placental Lesions in Meconium Aspiration Syndrome

BACKGROUND: Meconium aspiration syndrome (MAS) is defined by respiratory distress requiring supplemental oxygen in a meconium-stained neonate. MAS is clinically subclassified as mild, moderate, and severe according to the oxygen requirement. The aims of this study were to compare the histological findings in the placentas of MAS neonates with those of meconium-stained but non-MAS neonates and to analyze the correlation between the severity of MAS and the grade of its histological parameters. METHODS: We collected 160 singleton term placentas from neonates with meconium staining at birth from a tertiary medical center, Seoul, Republic of Korea. We reviewed hematoxylin and eosin sections of tissue samples (full-thickness placental disc, chorioamniotic membranes, and umbilical cord). RESULTS: Funisitis was present more frequently in MAS than in non-MAS (p < .01), of which the stage was correlated with the severity of MAS (p < .001). The histological findings consistent with maternal underperfusion and chronic deciduitis were more frequent in MAS than in non-MAS (p < .05). There was a correlation between the degree of chorionic vascular muscle necrosis and the severity of MAS (p < .05). CONCLUSIONS: Our results suggest that fetal inflammatory response evidenced by funisitis occurs prenatally in MAS and that the stage of funisitis and of chorionic vascular muscle necrosis may be a predictive marker of the severity of MAS.

Comparison between Patients with Persistent Pulmonary Hypertension of Neonates Concomitant with Parenchymal Lung Disease and Idiopathic Persistent Pulmonary Hypertension of Neonates

PURPOSE: We aimed to compare the clinical characteristics between neonates with persistent pulmonary hypertension of neonates (PPHN) with parenchymal lung disease (PLD) and those with idiopathic PPHN. METHODS: We reviewed the medical records of 67 neonates with gestational ages not lesser than 34⁺⁰ weeks who were born at Inje University Sanggye Paik Hospital between June 1, 2005 and December 31, 2016. We excluded 10 neonates who presented with congenital anomalies (n=3), dextrocardia (n=1), triple X syndrome (n=1), death before treatment (n=1), neonatal asphyxia (n=2), and congenital diaphragmatic hernia (n=2). Neonates were categorized into 2 groups—PPHN with PLD (PLD group, those diagnosed with PLD such as respiratory distress syndrome or meconium aspiration syndrome, n=36) and idiopathic PPHN (idiopathic group, n=21). We compared the clinical characteristics, treatment, and laboratory findings between the groups. RESULTS: The PLD group neonates showed a greater requirement for positive pressure ventilation in the delivery room, higher frequency of meconium staining of amniotic fluid, and greater need for surfactant application than those belonging to the idiopathic group. In contrast, epinephrine use was more common in the idiopathic PPHN group than in the PLD group. The 1-minute Apgar score and pH observed on initial capillary blood gas analysis were lower in the PLD than in the idiopathic group. Severity scores were higher in the idiopathic than in the PLD group 4–7 days after birth. CONCLUSION: In our study, an overall simplified severity score in the first week after birth was higher in the idiopathic than in the PLD group. These results were particularly statistically significant over postnatal days 4–7.

Meconium Aspiration Syndrome: The Core Concept of Pathophysiology during Resuscitation

Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of MAS. Most aspiration of meconium probably occurs before birth. Following aspiration, meconium may migrate to the peripheral airway, usually take about 2 hours as demonstrated in animal experiment, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diagnosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the management of MAS. Recent studies suggest that avoidance of post-term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso-and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction at birth is considered a controversial procedure and only reserved for infants who have severe retraction at birth suggesting an upper airway obstruction. High frequency oscillatory ventilation with nitric oxide or surfactant may improve mortality. Mortality of MAS has improved; the causes of death are related primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.

Clinical effect of high-frequency oscillatory ventilation combined with pulmonary surfactant in treatment of neonatal severe meconium aspiration syndrome complicated by pulmonary hemorrhage / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical effect and safety of high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal severe meconium aspiration syndrome (MAS) complicated by neonatal pulmonary hemorrhage (NPH).</p><p><b>METHODS</b>A total of 48 children with severe MAS complicated by NPH were enrolled, and a retrospective analysis was performed for the clinical effects of HFOV+PS (trial group, 25 children) and HFOV alone (control group, 23 children). The blood gas parameters, oxygenation index (OI), PaO/FiO(P/F) value, duration of pulmonary hemorrhage, ventilation time, length of hospital stay, incidence of complications, and outcome were compared between the two groups.</p><p><b>RESULTS</b>At 6, 12, 24, and 48 hours after treatment, the trial group had significantly better PaO, OI, and P/F value than the control group (P<0.05). Compared with the control group, the trial group had significantly shortened ventilation time and duration of pulmonary hemorrhage (P<0.05). There were no significant differences in the length of hospital stay, the incidence of complications, and cure rate between the two groups (P>0.05).</p><p><b>CONCLUSIONS</b>HFOV combined with PS can better improve oxygenation function and shorten the duration of NPH and ventilation time. Meanwhile, it does not increase the incidence of adverse events. Therefore, it is a safe and effective therapy.</p>

Clinical efficacy of porcine pulmonary surfactant combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the clinical efficacy of porcine pulmonary surfactant (PS) combined with budesonide suspension intratracheal instillation in the treatment of neonatal meconium aspiration syndrome (MAS).</p><p><b>METHODS</b>Seventy neonates with MAS were enrolled for a prospective study. The neonates were randomly assigned to PS alone treatment group and PS+budesonide treatment group (n=35 each). The PS alone treatment group was given PS (100 mg/kg) by intratracheal instillation. The treatment group was given budesonide suspension (0.25 mg/kg) combined with PS (100 mg/kg).</p><p><b>RESULTS</b>The rate of repeated use of PS in the PS+ budesonide group was significantly lower than that in the PS alone group 12 hours after treatment (p<0.05). The improvement of PaO/FiO, TcSaO, PaO, and PaCOin the PS+ budesonide group was significantly greater than that in the PS alone group 6, 12, and 24 hours after treatment (p<0.05). The chest X-ray examination showed that the pulmonary inflammation absorption in the PS+ budesonide group was significantly better than that in the PS alone group 48 hours after treatment (p<0.05). The incidence of complications in the PS+budesonide group was significantly lower than that in the PS alone group (p<0.05), and the average hospitalization duration was significantly shorter than that in the PS alone group (p<0.01).</p><p><b>CONCLUSIONS</b>PS combined with budesonide suspension intratracheal instillation for the treatment of neonatal MAS is effective and superior to PS alone treatment.</p>

Síndrome da aspiração meconial: identificando situações de risco obstétricos e neonatais / Síndrome de aspiración de meconio: identificando situaciones de riesgo obstétrico y neonatal / Meconium aspiration syndrome: identifying obstetric and neonatal risk situations

Objective: To identify situations of obstetric and neonatal risk that favored meconium aspiration syndrome as well as complications in clinical evolution presented by these neonates. Method: It is a quantitative, retrospective study and documentary analysis, conducted from January 2009 to December2010. Data from 40 medical records were recorded in a database and analyzed using descriptive statistical analysis software. Results: 67.5 % of mothers had fewer than six prenatal consultations and 42.5% had complications during pregnancy. Cesarean section predominated with 75%, indicated by fetal distress. There were 90% of neonates had an average gestational age of 37 weeks or more, 82.5 % had an Apgar score below 7, requiring resuscitation at birth and ventilatory support. Conclusion: Proper monitoring of pregnant women through out pregnancy cycle and in labor as well as the need to care for neonates in the delivery room can reduce the incidence of the syndrome.

Objetivo: Identificar as situações de risco obstétricas e neonatais que favorecem a síndrome da aspiração meconial, bem como as complicações na evolução clínica apresentadas por esses neonatos. Método: Estudo quantitativo, retrospectivo e de análise documental, realizado entre janeiro de 2009 a dezembro de 2010. Os dados dos 40 prontuários consultados foram registrados em banco de dados e analisados por meio de software para análise estatística descritiva. Resultados: Quanto às genitoras, 67,5% tiveram menos que seis consultas de pré-natal e 42,5% intercorrências na gestação. Predominou o parto cesáreo em 75%, indicados por sofrimento fetal. Dos neonatos, 90% apresentaram idade gestacional de 37 semanas ou mais; 82,5% tiveram Apgar abaixo de 7, necessitando de reanimação ao nascer e suporte ventilatório. Conclusão: O acompanhamento adequado da gestante em todo ciclo grávido e no trabalho de parto, bem como o atendimento preciso do neonato na sala de parto podem reduzir a incidência da síndrome.

Objetivo: Identificar las situaciones de riesgo obstétrico y neonatal que favoreció el síndrome de aspiración de meconio y complicaciones en la evolución clínica que presentan estos neonatos. Método: Estudio cuantitativo, retrospectivo y de análisis documental, realizado a partir de enero 2009 a diciembre2010. Los datos de 40 historias clínicas se registraron en una base de datos y se analizaron con el software de análisis estadístico descriptivo. Resultados: En cuanto a las madres, el 67,5 % tenían menos de seis consultas prenatales y un 42,5 % de complicaciones durante el embarazo. Cesárea predominó en el 75%, indicado por sufrimiento fetal. De los recién nacidos, el 90% tenían una media de edad gestacional de 37 semanas o más, el 82,5% tenía una puntuación de Apgar por debajo de 7, necesitando reanimación al nacery el apoyo ventilatorio. Conclusión: El control adecuado de la mujer embarazada durante el ciclo de embarazo y en el parto, así como la necesidad de cuidar a los recién nacidos en la sala de parto puede reducir la incidencia del síndrome.