He Xiao-Guang, Li Jin-Feng, Xu Feng-Dan, Xie Hao-Qiang, Huang Tian-Li
Department of Neonatology, Dongguan Children's Hospital Affiliated to Guangdong Medical University, Dongguan, Guangdong 523325, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Jun 15;24(6):662-668. doi: 10.7499/j.issn.1008-8830.2202011.
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).
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 (=199), a mild/moderate MAS group (=77), and a severe MAS group (=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.
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 (<0.05) and a significantly higher blood lactate level in the umbilical artery (<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 (<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) >30.345×10/L at 1 hour after birth were early predicting indicators for severe MAS in neonates with MSAF (<0.05).
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.
研究重度胎粪吸入综合征（MAS）的临床特征以及羊水胎粪污染（MSAF）新生儿发生重度MAS的早期预测因素。
选取2018年1月至2019年12月因Ⅲ° MSAF住院的295例新生儿作为研究对象。将新生儿分为非MAS组（n = 199）、轻度/中度MAS组（n = 77）和重度MAS组（n = 19）。对一般临床资料、血气参数、感染指标及母亲围产期临床资料进行回顾性分析。比较三组出生后的呼吸支持方案。采用受试者工作特征（ROC）曲线及多因素logistic回归分析探讨MSAF新生儿发生重度MAS的预测因素。
295例MSAF新生儿中，32.5%（96/295）发生MAS，其中20%（19/96）为重度MAS。与轻度/中度MAS组和非MAS组相比，重度MAS组5分钟Apgar评分显著更低（P < 0.05），脐动脉血乳酸水平显著更高（P < 0.05）。与非MAS组相比，重度MAS组出生后1小时外周血白细胞介素-6（IL-6）水平显著更高（P < 0.017）。重度MAS组中，79%（15/19）的新生儿出生时无活力，其中13例行胎粪吸引，100%的新生儿在24小时内开始接受机械通气。出生后1小时外周血IL-6>39.02 pg/mL及白细胞计数（WBC）>30.345×10⁹/L是MSAF新生儿发生重度MAS的早期预测指标（P < 0.05）。
胎粪吸引不能完全预防MSAF新生儿发生重度MAS。重度MAS新生儿可能发生严重呼吸窘迫，出生后早期即需机械通气。密切监测出生后1小时脐动脉血乳酸及外周血IL-6和WBC可能有助于早期预测MAS的发生及严重程度。
