Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, South Africa

Meconium aspiration syndrome (MAS) is defined as respiratory distress in a neonate born through meconium-stained liquor (MSAL) whose symptoms cannot be otherwise explained. Mortality and morbidities vary in different resourced health settings. This retrospective study aimed to describe the management strategies, short-term (in-hospital) outcomes and mortality of neonates with severe MAS (defined as those requiring invasive ventilation) at a resource restricted hospital in Cape Town, South Africa.
Ninety-two neonates with suspected MAS were included, of which only 47 were included based on the radiological findings (patchy infiltrates and hyperinflation). The mean gestational age was 39.7 ± 1.4 weeks and mean birth weight was 3246 ± 522g. Most neonates were outborn. High frequency ventilation was the most common initial mode of ventilation (55%). The median duration of invasive ventilation was 3 (IQR 2-4.5) days and total duration of respiratory support was 9 (IQR 4-16) days. Surfactant was administered in 70% of neonates. Pulmonary hypertension (PPHN) developed in 53% and 88% received inhaled nitric oxide. Inotropes were administered to 45% of neonates and steroids were administered in 64%. Pneumothorax was present in 9%. Neonates were discharged from NICU after a median age of 5 (IQR 3-7) days and had a hospital stay of 12 (IQR 6-21) days. Overall mortality was 8.5% (n = 4).
Mortality was low and complications (PPHN and sepsis) were high, remaining higher than in high resource countries. Management of PPHN and hypotension, as well as steroid administration were variable. A protocolized management strategy should be adopted, according to resource availability.

What is already known about this topic?
Meconium aspiration syndrome is associated with a variety of complications. Management is varied, mostly supportive and differs depending on health care resources.What does this article add to our knowledge? With combination of therapies, morbidities remain high but mortality decreases, in a resource restricted institution but remains higher than in high resource institutions. How does this study impact current management guidelines? Therapies – high frequency ventilation, surfactant, inotropes and inhaled nitric oxide – should be combined to improve outcomes, especially in resource restricted institutions.

Received: Oct 11, 2023
Accepted: Dec 06, 2023
Published: Mar 1, 2024

Table of Contents: Private: Vol. 2, n. 1, March 2024

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