Possible causes linking asphyxia, thick meconium and respiratory distress

Area of Science:

• Perinatology
• Neonatology
• Obstetrics

Background:

• Meconium-stained liquor is a known risk factor for adverse neonatal outcomes.
• The precise causes of fetal distress and respiratory distress (RD) in neonates exposed to meconium are not fully understood.

Purpose of the Study:

• To investigate the causes of fetal distress and respiratory distress in infants born following meconium-stained liquor.
• To identify contributing factors such as fetal malnutrition, infection, and meconium aspiration syndrome.

Main Methods:

• Prospective study conducted over one year in a tertiary referral maternity hospital.
• Inclusion criteria: infants born after meconium-stained liquor who developed RD.
• Assessment of fetal distress (CTG, cord blood pH, Apgar score), causes of fetal distress (maternal factors, infection, malnutrition), and causes of RD (MAS, PPHN, infection).

Main Results:

• Out of 4,026 livebirths, 717 (17.8%) had meconium-stained liquor; 44 term and 5 preterm infants developed RD.
• Term infants with RD frequently showed signs of fetal distress, linked to fetal malnutrition (35-41% reduced skinfold thickness) and histological chorioamnionitis (74%).
• Causes of RD identified in 48% of term infants: PPHN (41%), MAS (16%), infection (2%). In preterm infants, 80% had suspected or definite infection.

Conclusions:

• Fetal distress is a common precursor to respiratory distress in infants exposed to meconium-stained liquor.
• Histological chorioamnionitis and fetal malnutrition appear to contribute to the vulnerability of term infants to intrapartum fetal distress.
• Infection is a significant cause of respiratory distress, particularly in preterm infants exposed to meconium-stained liquor.