Meconium Aspiration Syndrome: Intrapartum Care and Management

Yıl 2019, Cilt: 6 Sayı: 3, 630 - 635, 01.10.2019

Deniz Batman Ayden Çoban

Öz

DOI: 10.5152/hsp.2019.463966  

Meconium-stained amniotic fluid (MSAF) is
defined as the excretion of meconium in the intrauterine period and its
migration to the amnion fluid. MAS is a leading cause of mortality and
morbidity in newborns. Early detection of MAS, early intervention, and correct
intrapartum approach can lead to a reduction in the mortality and morbidity
rates. The intrapartum approach to newborns with MAS has changed over the
years. In the past years, deep tracheal aspiration was recommended for every
baby born with MAS who did not cry and was hypotonic and non-breathing . When
the current recommendations of the Turkish Neonatology Association, the
American Pediatric Academy Neonatal Resuscitation Guide, and the International
Resuscitation Committee were examined, it was found that intrapartum aspiration
was not recommended for infants born with MAS. By providing a current approach
to newborns with MAS, the mortality and morbidity rates may be reduced. In this
study, the current approaches in care delivery for newborns with meconium
aspiration syndrome have been investigated.

Cite this article as: Batman D, Çoban A.
Meconium Aspiration Syndrome: Intrapartum Care and Management. Journal of
Health Science and Profession 2019; 6(3): 630-35.

Anahtar Kelimeler

Meconium aspiration syndrome, newborn, midwifery

Mekonyum Aspirasyon Sendromu: İntrapartum Bakım ve Yaklaşım

Öz

DOI: 10.5152/hsp.2019.463966  

Mekonyum çıkışının intrauterin dönemde
olması ve amnion sıvısına geçmesi sonucu, yenidoğanın intrauterin dönem veya
doğumda mekonyumu aspire etmesi mekonyum aspirasyon sendromu (MAS) olarak ifade
edilmektedir. MAS yenidoğanlarda mortalite ve morbiditenin önde gelen
nedenlerindendir. MAS’ın erken dönemde belirlenmesi, erken müdahale ve
intrapartum doğru yaklaşım ile MAS oranları ve böylece mortalite ve morbidite
oranları da azaltılabilecektir. Yıllar içerisinde MAS’lı yenidoğanlara
intrapartum yaklaşım uygulamaları değişiklik göstermiştir. Geçmiş yıllarda
MAS’lı doğan, ağlamayan ve hipotonik deprese her bebeğe derin trakeal aspirasyon
önerilirken günümüzde bu uygulama rutinden kaldırılmıştır. Türk Neonatoloji
Derneği, Amerikan Pediatri Akademisi Yenidoğan Resusitasyon Klavuzu ve
Uluslararası Resüsitasyon Komitesi’nin güncel önerileri incelendiğinde, MAS’lı
doğan bebeklerde intrapartum aspirasyon önerilmemektedir. MAS’lı yenidoğanlara
güncel yaklaşımın sağlanmasıyla mortalite ve morbidite oranlarının da azalması
sağlanabilecektir. Bu çalışmada, mekonyum aspirasyon sendromu ile doğan
yenidoğanda doğum odasında bakım uygulamalarında güncel yaklaşımlar
incelenmiştir. 

Cite this article as: Batman D, Çoban A.
Meconium Aspiration Syndrome: Intrapartum Care and Management. Journal of
Health Science and Profession 2019; 6(3): 630-35.

Anahtar Kelimeler

mekonyum aspirasyon sendromu, yenidoğan, ebelik

Kaynakça

• Türkiye nüfus ve sağlık araştırması. Ha-cettepe üniversitesi nüfus etütleri ens-titüsü, TC Kalkınma Bakanlığı ve TÜ-BİTAK, Ankara, Türkiye, 2013. (Erişim Tarihi: 30/07/2018) Erişim adresi http://www.hips.hacettepe.edu.tr/tnsa2013/rapor/TNSA_2013_ana_rapor.pdf.
• Singh BS, Clark RH, Powers RJ, Spitzer AR. Meconium aspiration syndrome remains a significant prob¬lem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol 2009; 29: 497-503.
• Lee J, Romero R, Lee K, Kim EN, Korzeniewski SJ, Chaemsaithong P et al. Meconium aspiration syndrome: a role for fetal systemic inflammation. American Journal of Obstetrics and Gynecology 2016; 214(3): 366-371.
• Vivian-Taylor J, Sheng J, Hadfield RM, Morris JM, Bowen JR, Roberts CL. Trends in obstetric practices and meconium aspiration syndrome: a population-based study. British Journal of Obstetrics and Gynaecology 2011; 118: 1601-1607.
• Khazardoost S, Hantoushzadeh S, Khooshideh M, Borna M. Risk factors for meconium aspiration in meconium stained amniotic fluid. Journal of Obstetrics and Gynecology 2007; 27: 577-579.
• Anwar Z, Butt TK, Kazi MY. Mortality in meconium aspiration syndrome in hospitalized babies. J Coll Physicians Surg Pak 2011; 21(11): 695-699.
• Bhat RY, Rao A. Meconium-stained amniotic fluid and meconium aspiration syndrome: a prospective study. Annals of Tropical Paediatrics 2008; 28: 199-203.
• Xu H, Calvet M, Wei S, Luo ZC, Fraser WD. Amnioinfusion study group. Risk factors for early and late onset of respiratory symptoms in babies born through meconium. Am J Perinatol 2010; 27: 271-278.
• Türk Neonatoloji Derneği Doğum Sa¬lonu Yönetimi Rehberi, Ankara, Tür¬kiye, 2016 (Erişim Tarihi: 05/08/2018) Erişim adresi http://www.neonatology.org.tr/images/stories/rehberler2016/dogum_odasi_yonetimi.pdf.
• Uslu S, Dursun M, Bülbül A. [Meconium aspiration syndrome (MAS)]. Şişli Etfal Tıp Bülteni 2015;49(2):85-95.
• Qian L, Liu C, Zhuang W, Guo Y, Yu J, Chen H et al. Neonatal respiratory failure: a 12-month clinical epidemiologic study from 2004 to 2005 in China. Pediatrics 2008; 121(5): 1115-11124.
• Blackwell SC, Moldenhauer J, Hassan SS, Redman ME, Refuerzo JS, Berry SM et al. Meconium aspiration syndrome in term neonates with normal acid-base status at delivery: is it different?. American journal of obstetrics and gynecology 2001; 184(7): 1422-1426.
• Greenough A. Meconium aspiration syndrome-prevention and treatment. Early Hum Dev 1995; 41: 183-192.
• Yoder BA, Kirsch EA, Barth WH, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstetrics and Gynecology 2002; 99(5): 731-739,
• Wiswell TE, Knight GR, Finer NN, Donn SM, Desai H, Walsh WF et al. A multicenter, randomized, controlled trial comparing Surfaxin (Lucinactant) lavage with standard care for treatment of meconium aspiration syndrome. Pediatrics 2002; 109: 1081-1087.
• Choi W, Jeong H, Choi SJ, Oh SY, Kim JS, Roh CR et al. Risk factors differentiating mild/moderate from se-vere meconium aspiration syndrome in meconium-stained neonates. Obstetrics&Gynecology Science 2015; 58(1): 24-31.
• Yurdakok M. Meconium aspiration syndrome: do we know?. The Turkish Journal of Pediatrics 2011; 53: 121-129.
• Paz Y, Solt I, Zimmer E. Variables associated with meconium aspiration syndrome in labors with thick meconium. Eur J Obstet Gynecol Reprod Biol 2001; 94: 27-30.
• Wiswell TE. Advances in the treatment of the meconium aspiration syndrome. Acta Paediatrica 2001; 90: 28-30.
• Louis D, Sundaram V, Mukhopadhyay K, Dutta S, Kumar P. Predictors of mortality in neonates with meconium aspiration syndrome. Indian Pediatrics 2014; 51(8): 637-640.
• Dargaville P, Copnell B. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies and outcome. Pediatrics 2006; 117(5): 1712-1721.
• Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. International Journal of Pediatrics 2012; 1-7.
• Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pe¬diatr 2012; DOI:321545.
• Hofer N, Jank K, Resch E, Urlesberger B, Reiterer F, Resch B. Meconium aspiration syndrome a 21-years experience from a tertiary care center and analysis of risk factors for predicting disease severity. Klin Padiatr 2013; 225(7): 383-388.
• Hutton EK, Thorpe J. Consequences of meconium stained amniotic fluid: What does the evidence tell us?. Early Human Development 2014; 90(7): 333-339.
• Osava RH, Silva FM, Vasconcellos de Oliveira SM, Tuesta EF, Amaral MC. Meconium-stained amniotic fluid and maternal and neonatal factors associated. Revista de Saude Publica 2012; 46: 1023-1029.
• Xu H, Mas-Calvet M, Wei SQ, Luo ZC, Fraser WD. Abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid: association with perinatal outcomes. American Journal of Perinatology 2009; 200(3): 1-7.
• Gulmezoglu AM, Crowther CA, Middleton P. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database of Systematic Reviews (Online) 2006; DOI: CD004945.
• Bhutani VK. Developing a systems approach to prevent meconium aspiration syndrome: lessons learned from multinational studies. Journal of Perinatology 2008; 28(3): 30-35.
• Salvia-Roiges MD, Carbonell-Estrany X, FiguerasAloy J, Rodrigues-Miguelez JM. Efficacy of three treatment schedules in severe meconium aspiration syndrome. Acta Paediatrica 2004; 93: 60-65.
• Van Ierland Y, de Beaufort AJ. Why does meconium cause meconium aspiration syndrome? Current concepts of MAS pat¬hophysiology. Early Hum Dev 2009; 85: 617-620.
• El Shahed AI, Dargaville PA, Ohlsson A, Soll R. Surfactant for meconium aspiration syndrome in term and late preterm in¬fants. Cochrane Database Syst Rev. 2014; DOI: CD002054.
• Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, Weiss K et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics 2000; 105(1): 1-7.
• Neonatal Resuscitation Textbook 6th Edition, American Academy of Pediatrics, 2011 (Erişim Tarihi: 30/06/2018) Erişim adresi:http://reader.aappublications.org/nrp-neonatal-resuscitation-textbook-6th-edition-english-version/12.
• International Liaison Committee on Resuscitation, Part 7: Neonatal Resuscitation 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations, 2015; 132(1): 204-241: DOI:10.1161/CIR.0000000000000276.
• Bhat R, Vidyasagar D. Delivery room management of meconium-stained infant. Clinics in perinatology 2012; 39(4): 817-831.
• Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015; 132(2): DOI:S543-60.
• International Confederation of Midwives. ICM international definition of the midwife, The Netherlands, Amsterdam, 2011. (Erişim Tarihi: 30/06/2018) Erişim adresi:http://internationalmidwives.org/assets/uploads/documents/Definition%20of%20the%20Midwife%20-%202011.pdf
• Tababet ve Şuabatı San'atlarının Tarzı İc-rasına Dair Kanun. Türkiye 1928. (Erişim Tarihi: 30/06/2018) Erişim adresi:http://www.mevzuat.gov.tr/MevzuatMetin/1.3.1219.pdf
• TC Sağlık Bakanlığı, Sağlık Meslek Mensupları İle Sağlık Hizmetle-rinde Çalışan Diğer Meslek Mensupla-rının İş Ve Görev Tanımlarına Dair Yönetmelik, Ankara, Türkiye, 2014 (Erişim Tarihi: 01/08/2018) Erişim adresi:http://www.resmigazete.gov.tr/eskiler/2014/05/20140522-14.htm.