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

Abstract

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.