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Pattern of Inflammatory Markers and Use of Antibiotics in Meconium Aspiration Syndrome: A Retrospective Cohort Study
Uvaraj Periasamy1, Agnes Salvador2, Michael Janeczko2
1Anesthesiology and Critical Care, Boston Children's Hospital, Boston, USA.
Abstract:
Objectives To study the pattern of inflammatory markers in meconium aspiration syndrome (MAS) and their correlation with illness severity/antibiotic usage. Study design This is a retrospective analysis of neonates who were admitted with MAS and had inflammatory markers done during the first week of life. Results Seventy-six neonates with MAS were identified. White cell count (WCC), absolute neutrophil count (ANC), and immature to total neutrophil count (I/T) ratio peaked at 12 and CRP (43.75 mg/dl) at 48 hours of life (HOL). Neonates needing nasal cannula oxygen had lower CRP at 12 (p=0.035) and 24 HOL (p=0.046). There was no correlation between CRP at 48 HOL and score for neonatal acute physiology and perinatal extension II (SNAPPE-II; R2 0.0004). High CRP at 24 HOL was associated with longer duration of antibiotics (p<0.001) despite no correlation with the blood cultures. Conclusion MAS was associated with inflammatory markers peaking at 12 to 48 HOL; however, antibiotics should not be determined based on them as their correlation for illness severity or blood culture is poor.
Insights
Inflammatory markers like CRP in meconium aspiration syndrome (MAS) peak within 48 hours of life. However, these markers poorly correlate with illness severity or blood cultures, suggesting caution in using them for antibiotic decisions.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Pathology
Background:
- Meconium aspiration syndrome (MAS) is a significant cause of neonatal respiratory distress.
- Understanding the inflammatory response in MAS is crucial for management.
- Current guidelines for antibiotic use in MAS require further investigation regarding inflammatory markers.
Purpose of the Study:
- To investigate the temporal patterns of inflammatory markers in neonates with MAS.
- To assess the correlation between these inflammatory markers and the severity of illness.
- To evaluate the relationship between inflammatory markers and antibiotic usage in MAS.
Main Methods:
- Retrospective analysis of 76 neonates admitted with MAS.
- Measurement of inflammatory markers including White Cell Count (WCC), Absolute Neutrophil Count (ANC), Immature to Total Neutrophil (I/T) ratio, and C-reactive protein (CRP).
- Correlation analysis with illness severity scores (e.g., SNAPPE-II) and antibiotic duration.
Main Results:
- WCC, ANC, and I/T ratio peaked at 12 hours of life (HOL); CRP peaked at 48 HOL.
- Lower CRP levels at 12 and 24 HOL were observed in neonates requiring nasal cannula oxygen.
- High CRP at 24 HOL correlated with longer antibiotic duration but not with blood cultures or SNAPPE-II score.
Conclusions:
- MAS is characterized by a distinct pattern of inflammatory marker elevation within the first 48 HOL.
- Inflammatory markers show a poor correlation with illness severity (SNAPPE-II) and blood culture results.
- Antibiotic therapy decisions in MAS should not solely rely on inflammatory marker levels due to their limited predictive value for severity and infection.
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