Prediction of the severity of meconium aspiration syndrome

C. Hernandez, B. B. Little, J. S. Dax, L. C. Gilstrap, C. R. Rosenfeld

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

OBJECTIVE: Meconium aspiration syndrome is associated with increased neonatal morbidity and mortality. We sought to determine whether the need for neonatal mechanical ventilation or prolonged ventilation (≥ 3 days) was predictable from antepartum, intraparfum, and immediate neonatal events. STUDY DESIGN: Between 1987 and 1989, 8003 of 43,906 (18%) live infants had meconium-stained amniotic fluid; 82 of these infants had clinical and radiographic evidence of meconium aspiration, and of these 82, 39 (48%) required mechanical ventilation. Predictors of ventilation or prolonged ventilation were determined by means of stepwise logistic regression. RESULTS: Predictors of neonatal ventilation included fetal tachycardia, interval from meconium detection to delivery, low 5-minute Apgar score, respiratory distress necessitating intubation in the delivery suite, and delivery by cesarean section. Sensitivity was 72%, and specificity was 64%; the model was incorrect in 32% of the cases. Predictors of prolonged ventilation were ominous fetal heart rate tracing, umbilical arterial pH < 7.20, birth weight > 90th percentile, nulliparity, and Apgar score > 4 at 1 minute and ≤ 6 at 5 minutes. Sensitivity was 67%, and specificity was 91%; prolonged ventilation was incorrectly predicted in 17% of the cases. CONCLUSIONS: Use of these models to determine the need for mechanical ventilation or prolonged ventilatory assistance will enhance identification of infants at risk of severe meconium aspiration and will lead to early transfer to the neonatal intensive care unit for intense observation and management.

Original languageEnglish (US)
Pages (from-to)61-70
Number of pages10
JournalAmerican Journal of Obstetrics and Gynecology
Volume169
Issue number1
StatePublished - 1993

Fingerprint

Meconium Aspiration Syndrome
Ventilation
Artificial Respiration
Meconium
Apgar Score
Umbilicus
Fetal Heart Rate
Neonatal Intensive Care Units
Infant Mortality
Amniotic Fluid
Parity
Intubation
Tachycardia
Cesarean Section
Logistic Models
Observation
Morbidity

Keywords

  • fetal monitoring
  • mechanical ventilation
  • meconium aspiration
  • neonatal

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Hernandez, C., Little, B. B., Dax, J. S., Gilstrap, L. C., & Rosenfeld, C. R. (1993). Prediction of the severity of meconium aspiration syndrome. American Journal of Obstetrics and Gynecology, 169(1), 61-70.

Prediction of the severity of meconium aspiration syndrome. / Hernandez, C.; Little, B. B.; Dax, J. S.; Gilstrap, L. C.; Rosenfeld, C. R.

In: American Journal of Obstetrics and Gynecology, Vol. 169, No. 1, 1993, p. 61-70.

Research output: Contribution to journalArticle

Hernandez, C, Little, BB, Dax, JS, Gilstrap, LC & Rosenfeld, CR 1993, 'Prediction of the severity of meconium aspiration syndrome', American Journal of Obstetrics and Gynecology, vol. 169, no. 1, pp. 61-70.
Hernandez, C. ; Little, B. B. ; Dax, J. S. ; Gilstrap, L. C. ; Rosenfeld, C. R. / Prediction of the severity of meconium aspiration syndrome. In: American Journal of Obstetrics and Gynecology. 1993 ; Vol. 169, No. 1. pp. 61-70.
@article{038f9c2fad5c4183ac6f7ed1d947161f,
title = "Prediction of the severity of meconium aspiration syndrome",
abstract = "OBJECTIVE: Meconium aspiration syndrome is associated with increased neonatal morbidity and mortality. We sought to determine whether the need for neonatal mechanical ventilation or prolonged ventilation (≥ 3 days) was predictable from antepartum, intraparfum, and immediate neonatal events. STUDY DESIGN: Between 1987 and 1989, 8003 of 43,906 (18{\%}) live infants had meconium-stained amniotic fluid; 82 of these infants had clinical and radiographic evidence of meconium aspiration, and of these 82, 39 (48{\%}) required mechanical ventilation. Predictors of ventilation or prolonged ventilation were determined by means of stepwise logistic regression. RESULTS: Predictors of neonatal ventilation included fetal tachycardia, interval from meconium detection to delivery, low 5-minute Apgar score, respiratory distress necessitating intubation in the delivery suite, and delivery by cesarean section. Sensitivity was 72{\%}, and specificity was 64{\%}; the model was incorrect in 32{\%} of the cases. Predictors of prolonged ventilation were ominous fetal heart rate tracing, umbilical arterial pH < 7.20, birth weight > 90th percentile, nulliparity, and Apgar score > 4 at 1 minute and ≤ 6 at 5 minutes. Sensitivity was 67{\%}, and specificity was 91{\%}; prolonged ventilation was incorrectly predicted in 17{\%} of the cases. CONCLUSIONS: Use of these models to determine the need for mechanical ventilation or prolonged ventilatory assistance will enhance identification of infants at risk of severe meconium aspiration and will lead to early transfer to the neonatal intensive care unit for intense observation and management.",
keywords = "fetal monitoring, mechanical ventilation, meconium aspiration, neonatal",
author = "C. Hernandez and Little, {B. B.} and Dax, {J. S.} and Gilstrap, {L. C.} and Rosenfeld, {C. R.}",
year = "1993",
language = "English (US)",
volume = "169",
pages = "61--70",
journal = "American Journal of Obstetrics and Gynecology",
issn = "0002-9378",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Prediction of the severity of meconium aspiration syndrome

AU - Hernandez, C.

AU - Little, B. B.

AU - Dax, J. S.

AU - Gilstrap, L. C.

AU - Rosenfeld, C. R.

PY - 1993

Y1 - 1993

N2 - OBJECTIVE: Meconium aspiration syndrome is associated with increased neonatal morbidity and mortality. We sought to determine whether the need for neonatal mechanical ventilation or prolonged ventilation (≥ 3 days) was predictable from antepartum, intraparfum, and immediate neonatal events. STUDY DESIGN: Between 1987 and 1989, 8003 of 43,906 (18%) live infants had meconium-stained amniotic fluid; 82 of these infants had clinical and radiographic evidence of meconium aspiration, and of these 82, 39 (48%) required mechanical ventilation. Predictors of ventilation or prolonged ventilation were determined by means of stepwise logistic regression. RESULTS: Predictors of neonatal ventilation included fetal tachycardia, interval from meconium detection to delivery, low 5-minute Apgar score, respiratory distress necessitating intubation in the delivery suite, and delivery by cesarean section. Sensitivity was 72%, and specificity was 64%; the model was incorrect in 32% of the cases. Predictors of prolonged ventilation were ominous fetal heart rate tracing, umbilical arterial pH < 7.20, birth weight > 90th percentile, nulliparity, and Apgar score > 4 at 1 minute and ≤ 6 at 5 minutes. Sensitivity was 67%, and specificity was 91%; prolonged ventilation was incorrectly predicted in 17% of the cases. CONCLUSIONS: Use of these models to determine the need for mechanical ventilation or prolonged ventilatory assistance will enhance identification of infants at risk of severe meconium aspiration and will lead to early transfer to the neonatal intensive care unit for intense observation and management.

AB - OBJECTIVE: Meconium aspiration syndrome is associated with increased neonatal morbidity and mortality. We sought to determine whether the need for neonatal mechanical ventilation or prolonged ventilation (≥ 3 days) was predictable from antepartum, intraparfum, and immediate neonatal events. STUDY DESIGN: Between 1987 and 1989, 8003 of 43,906 (18%) live infants had meconium-stained amniotic fluid; 82 of these infants had clinical and radiographic evidence of meconium aspiration, and of these 82, 39 (48%) required mechanical ventilation. Predictors of ventilation or prolonged ventilation were determined by means of stepwise logistic regression. RESULTS: Predictors of neonatal ventilation included fetal tachycardia, interval from meconium detection to delivery, low 5-minute Apgar score, respiratory distress necessitating intubation in the delivery suite, and delivery by cesarean section. Sensitivity was 72%, and specificity was 64%; the model was incorrect in 32% of the cases. Predictors of prolonged ventilation were ominous fetal heart rate tracing, umbilical arterial pH < 7.20, birth weight > 90th percentile, nulliparity, and Apgar score > 4 at 1 minute and ≤ 6 at 5 minutes. Sensitivity was 67%, and specificity was 91%; prolonged ventilation was incorrectly predicted in 17% of the cases. CONCLUSIONS: Use of these models to determine the need for mechanical ventilation or prolonged ventilatory assistance will enhance identification of infants at risk of severe meconium aspiration and will lead to early transfer to the neonatal intensive care unit for intense observation and management.

KW - fetal monitoring

KW - mechanical ventilation

KW - meconium aspiration

KW - neonatal

UR - http://www.scopus.com/inward/record.url?scp=0027254637&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0027254637&partnerID=8YFLogxK

M3 - Article

C2 - 8333477

AN - SCOPUS:0027254637

VL - 169

SP - 61

EP - 70

JO - American Journal of Obstetrics and Gynecology

JF - American Journal of Obstetrics and Gynecology

SN - 0002-9378

IS - 1

ER -