Silva Costa Inês, Alarcão Jose, Rodrigues Silva Ana, Henriques Raquel
Pediatrics Department, Unidade Local de Saúde (ULS) de Viseu Dão-Lafões, Viseu, PRT.
Neonatology Department, Unidade Local de Saúde (ULS) de Coimbra, Coimbra, PRT.
Cureus. 2024 Nov 2;16(11):e72894. doi: 10.7759/cureus.72894. eCollection 2024 Nov.
Meconium aspiration syndrome (MAS) is a respiratory condition associated with high morbimortality. Standards of care changed over the years addressing its specificities, aiming to decrease poor respiratory and neurologic long-term outcomes. This study aims to compare the practice and outcomes of MAS in a level III neonatal intensive care unit before and after the revision of the 2015 Neonatal Resuscitation Program (NRP).
A 15-year retrospective cohort of patients with MAS was assessed regarding perinatal management, clinical outcome, and neurodevelopmental follow-up.
A total of 52 MAS occurred, 51.9% (n=27) male gender, median gestational age 40 weeks (IQR 39-40), and mean birth weight of 3395±503 g. Recommendations of the NRP were implemented with a significant change in the management in the delivery room, as positive pressure ventilation was more frequent (p=0.001). No significant change was found in the clinical span or morbidity of MAS after NRP, except for lower acidosis (pH 7.0 vs. 7.2; p=0.042) and lower hyperlactatemia (12.2 vs. 6.4 mmol/l; p=0.035). Overall acute complications included pulmonary hypertension (21.2%, n=11) and pneumothorax (15.4%, n=8). To date, morbidity during follow-up didn't differ after NRP concerning global development delay (p=0.591), neurologic sequelae (p=0.276), and recurrent bronchospasm (p=0.614), in contrast with speech delay, which was less frequent in the later subgroup (p=0.023).
SAM persists as a concerning condition. From our data, the NRP showed no inferiority in the clinical outcomes, consistent with the literature but with higher frequency. Late morbidity is still a problem concerning cerebral palsy and global development delay, similar to known data.
胎粪吸入综合征（MAS）是一种与高病死率相关的呼吸系统疾病。多年来，针对其特殊性的护理标准不断变化，旨在减少不良的呼吸和神经方面的长期后果。本研究旨在比较2015年新生儿复苏计划（NRP）修订前后，三级新生儿重症监护病房中MAS的治疗实践及结果。
对一组15年的MAS患者回顾性队列进行围产期管理、临床结局及神经发育随访评估。
共发生52例MAS，男性占51.9%（n = 27），中位胎龄40周（四分位间距39 - 40周），平均出生体重3395±503g。NRP的建议得以实施，产房管理有显著变化，因为正压通气更频繁（p = 0.001）。NRP实施后，MAS的临床病程或发病率无显著变化，但酸中毒情况有所改善（pH值7.0对7.2；p = 0.042），高乳酸血症也有所降低（12.2对6.4 mmol/L；p = 0.035）。总体急性并发症包括肺动脉高压（21.2%，n = 11）和气胸（15.4%，n = 8）。到目前为止，随访期间的发病率在NRP实施后，关于整体发育迟缓（p = 0.591）、神经后遗症（p = 0.276）和复发性支气管痉挛（p = 0.614）并无差异，不过语言发育迟缓在后期亚组中发生率较低（p = 0.023）。
MAS仍是一个令人担忧的病症。从我们的数据来看，NRP在临床结局方面并不逊色，与文献一致但频率更高。后期发病率仍是一个与脑瘫和整体发育迟缓相关的问题，与已知数据相似。
