Impact of meconium consistency on infant resuscitation and respiratory outcomes: a retrospective-cohort study and systematic review

To compare short-term outcomes of infants born with thick versus thin meconium stained amniotic fluid (MSAF) and to perform a systematic review of the topic. A retrospective, single center, cohort study of infants’ ≥34 weeks’ gestation born with MSAF between 1 June 2013 and 30 September 2016. Birth resuscitation and respiratory outcomes were compared between the groups. A systematic review was conducted of similar studies published between 1 January 2000 and 30 June 2019. 1507 infants were eligible; 464 (30.8%) thick, 1,043 (69.2%) thin MSAF. The thick group required more respiratory support at birth and was 5.5-fold (95% CI: 2.51–11.95) more likely to and have meconium aspiration syndrome (MAS) and 2.1-fold more likely (95% CI: 0.89–4.83) to require either noninvasive respiratory support or intubation than the thin group. The thick group also had significantly higher oxygen supplementation >24 h (p p = .002). Across 12 studies included in the systematic review, infants with thick MSAF required more intensive birth resuscitation, ventilation support, with higher incidences of MAS. Study differences prohibited data comparisons and quantitative outcome evaluations. Infants with thick MSAF required more intensive birth resuscitation and ventilation support. Our findings need confirmation in robust, prospective cohort studies.

本研究旨在对比胎粪污染羊水（meconium stained amniotic fluid, MSAF）为浓稠型与稀薄型新生儿的短期结局，并针对该主题开展系统综述。研究纳入2013年6月1日至2016年9月30日期间出生的、胎龄≥34周且伴MSAF的新生儿，开展一项单中心回顾性队列研究，对比两组新生儿的出生复苏情况与呼吸结局；同时针对2000年1月1日至2019年6月30日发表的同类研究开展系统综述。最终纳入1507名符合条件的新生儿，其中464名（30.8%）为浓稠MSAF组，1043名（69.2%）为稀薄MSAF组。与稀薄组相比，浓稠组新生儿在出生时需要更多呼吸支持，发生胎粪吸入综合征（meconium aspiration syndrome, MAS）的风险是其5.5倍（95%置信区间：2.51~11.95）；需要无创呼吸支持或气管插管的风险是其2.1倍（95%置信区间：0.89~4.83）。浓稠组新生儿接受超过24小时氧疗的比例也显著更高（p=0.002）。系统综述纳入的12项研究结果显示，浓稠MSAF组新生儿需要更强化的出生复苏措施与通气支持，且MAS发生率更高；但各研究间存在异质性，无法进行数据合并与定量结局评估。浓稠MSAF组新生儿需要更强化的出生复苏与通气支持。本研究结果需在设计严谨的前瞻性队列研究中进一步验证。