THE INFLUENCE OF PERINATAL RISK FACTORS ON THE DEVELOPMENT OF MECONIUM ASPIRATION SYNDROME IN NEWBORN: IMPORTANT IN THE ROUTINE PRACTICE OF DOCTOR-NEONATOLOGIST

Abstract

The article summarizes the data on known risk factors for meconium aspiration syndrome (MAS) and those that continue to be studied to increase the effectiveness of the organization and provision of primary resuscitation for newly born, intensive care for newborns with MAS, prevention of aspiration pneumonia and complications of MAS, including early and late neonatal sepsis. MAS has not lost its relevance in recent years, despite studies of this problem on all continents and in almost every country in the world, which is associated with a high incidence of MAS, aspiration pneumonia, persistent pulmonary hypertension, and pneumothorax. The frequency of meconium in amniotic fluid is from 10 to 24%, and the implementation of meconium aspiration syndrome occurs in 3-12% of cases. MAS increases the frequency of antenatal, intranatal fetal death, as well as neonatal mortality to 4.2% in the case of severe meconium aspiration. Despite the scientifically proven link between the occurrence of meconium amniotic fluid and individual factors, including pregnancy, infection and hypoxia, which play a key role in the development of MAS, the degree of influence of these factors at different stages of pregnancy is still being studied. A study of the effect of hypoxia and infection on the imbalance between fetal defecation, urination, swallowing, respiratory tract secretion and amniotic fluid clearance. The differences between the value of physiological intrauterine defecation and pathological discharge of meconium in utero against the background of the infectious process in the mother (microbial colonization of the amniotic cavity funisitis), and fetal distress are shown. The role of delayed pregnancy, infection, and hypoxia during pregnancy in the development of MAS is emphasized, with an emphasis on the chronic course of these processes. It was pointed out that gestational age over 41 weeks cannot be considered a primary factor, in the risk of developing MAS, and the fact that body weight at birth is also important in the appearance of amniotic fluid contaminated with meconium and the development of MAS. If a pregnant woman has a microbial invasion of the amniotic cavity: chorioamnionitis or funisitis, the development of MAS is possible in a child born prematurely. Emphasized diagnostic value of intrauterine infection - a risk factor for MAS due to an increase in the norm of several inflammatory mediators identified in umbilical cord blood. The influence of circulatory disorders occurring in utero under the influence of stress and shock factors (functional disorders in the mother-placenta-fetus system, hypertension, late hestosis in the mother, dehydration, infection, metabolic disorders, bad habits). The additional focus of neonatologists to ensure objective monitoring of the condition of the fetus in maternity hospitals during the briefing, predicting the course of MAS will be insufficient justification for the indications for the use of oxytocin. Timely detection of new risk factors for MAS, the addition of importance in the development of MAS will help to improve and timely update birth protocols, in the presence of amniotic fluid contaminated with meconium, resuscitation and post-resuscitation care for newborns, optimize clinical routes.