Feeding problems with the first feed in neonates with meconium-stained amniotic fluid

To compare the incidence of feeding problems at the first feed between neonates born with meconium-stained amniotic fluid (MSAF) and those born without MSAF.

A prospective observational study conducted over a one-year period.

A level 2 neonatal unit.

A total of 2828 neonates were studied, including 275 neonates with MSAF. All neonates were born after more than 34 weeks of gestation, and had no birth asphyxia, hemodynamic, respiratory distress or major congenital anomalies. The neonates were offered a feed within 1 h of birth, and the incidence of early feeding problems (ie, retching, vomiting, slow feeding or poor suck) was studied.

Feeding problems at the first feed developed in 55 infants (13 of 275 with MSAF and 42 of 2533 without MSAF). Feeding problems were more common in infants with MSAF (P=0.001, relative risk=2.8, 95% CI 1.45 to 5.63), regardless of the type of MSAF (thin or thick). Although fetal distress was more frequent in the MSAF group, there were no differences in the 1 and 5 min Apgar scores whether meconium was present. Maternal sedation was not found to be a contributing factor. The mechanical and chemical actions of meconium inside the stomach requires further study.

Feeding problems at the first feed are 2.8 times more frequent in neonates born with MSAF, regardless of the consistency of the amniotic fluid. Mothers of such infants need to be informed and supported during feeding to minimize discouragement. The demands on the nursing staff must be anticipated accordingly.