Objective To study the clinical features and prognosis of neonates with severe meconium aspiration syndrome (MAS) and acute respiratory distress syndrome (ARDS). Methods A retrospective analysis was performed on the medical data of 60 neonates with severe MAS who were admitted from January 2017 to December 2019. According to the presence or absence of ARDS, they were divided into two groups: ARDS (n=45) and non-ARDS (n=15). Clinical features and prognosis were compared between the two groups. Results Among the 60 neonates with severe MAS, 45 (75%) developed ARDS. Arterial blood gas analysis showed that the ARDS group had a significantly higher median oxygenation index within 1 hour after birth than the non-ARDS group (4.7 vs 2.1, P<0.05), while there was no significant difference between the two groups in white blood cell count, C-reactive protein (CRP), and interleukin-6 (IL-6) on admission and the peak values of procalcitonin, CRP, and IL-6 during hospitalization (P>0.05). The ARDS group had a significantly higher incidence rate of shock than the non-ARDS group (84% vs 47%, P<0.05). There was no significant difference between the two groups in the incidence rates of persistent pulmonary hypertension, pneumothorax, pulmonary hemorrhage, hypoxic-ischemic encephalopathy, intracranial hemorrhage, and disseminated intravascular coagulation (P>0.05). The ARDS group required a longer median duration of mechanical ventilation than the non-ARDS group (53 hours vs 3 hours, P<0.05). In the ARDS group, 43 neonates (96%) were cured and 2 neonates (4%) died. In the non-ARDS group, all 15 neonates (100%) were cured. Conclusions Neonates with severe MAS and ARDS tend to develop respiratory distress earlier, require a longer duration of mechanical ventilation, and have a higher incidence rate of shock. During the management of children with severe MAS, it is recommended to closely monitor oxygenation index, give timely diagnosis and treatment of ARDS, evaluate tissue perfusion, and actively prevent and treat shock. Citation:
Key words
Severe meconium aspiration syndrome /
Acute respiratory distress syndrome /
Oxygenation index /
Neonate
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References
1 Olicker AL, Raffay TM, Ryan RM. Neonatal respiratory distress secondary to meconium aspiration syndrome[J]. Children (Basel), 2021, 8(3): 246. PMID: 33806734. PMCID: PMC8005197. DOI: 10.3390/children8030246.
2 Monfredini C, Cavallin F, Villani PE, et al. Meconium aspiration syndrome: a narrative review[J]. Children (Basel), 2021, 8(3): 230. PMID: 33802887. PMCID: PMC8002729. DOI: 10.3390/children8030230.
3 De Luca D, van Kaam AH, Tingay DG, et al. The Montreux definition of neonatal ARDS: biological and clinical background behind the description of a new entity[J]. Lancet Respir Med, 2017, 5(8): 657-666. PMID: 28687343. DOI: 10.1016/S2213-2600(17)30214-X.
4 张永芳, 于新桥, 廖建华, 等. 鄂西南地区新生儿急性呼吸窘迫综合征临床流行病学调查[J]. 中国当代儿科杂志, 2020, 22(9): 942-947. PMID: 32933623. PMCID: PMC7499450. DOI: 10.7499/j.issn.1008-8830.2003271.
5 De Luca D, Cogo P, Kneyber MC, et al. Surfactant therapies for pediatric and neonatal ARDS: ESPNIC expert consensus opinion for future research steps[J]. Crit Care, 2021, 25(1): 75. PMID: 33618742. PMCID: PMC7898495. DOI: 10.1186/s13054-021-03489-6.
6 周晓玉, 许植之, 武海燕, 等. 胎粪吸入综合征合并急性呼吸窘迫综合征探讨 (附52例临床病理分析)[J]. 新生儿科杂志, 2001, 16(1): 9-11. DOI: 10.3969/j.issn.1673-6710.2001.01.004.
7 周宇, 周晓光. 新生儿胎粪吸入综合征临床分型与特点的初步探讨[J]. 中国当代儿科杂志, 2000, 2(5): 311-314. DOI: 10.3969/j.issn.1008-8830.2000.05.003.
8 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
9 Chettri S, Bhat BV, Adhisivam B. Current concepts in the management of meconium aspiration syndrome[J]. Indian J Pediatr, 2016, 83(10): 1125-1130. PMID: 27206687. DOI: 10.1007/s12098-016-2128-9.
10 《中华儿科杂志》编辑委员会, 中华医学会儿科学分会新生儿学组. 新生儿机械通气常规[J]. 中华儿科杂志, 2015, 53(5): 327-330. DOI: 10.3760/cma.j.issn.0578-1310.2015.05.003.
11 吴玉斌, 韩玉昆. 新生儿休克诊断标准的探讨[J]. 中国实用儿科杂志, 1997, 12(2): 86-88.
12 Lindenskov PHH, Castellheim A, Saugstad OD, et al. Meconium aspiration syndrome: possible pathophysiological mechanisms and future potential therapies[J]. Neonatology, 2015, 107(3): 225-230. PMID: 25721501. DOI: 10.1159/000369373.
13 Hammoud MS, Raghupathy R, Barakat N, et al. Cytokine profiles at birth and the risk of developing severe respiratory distress and chronic lung disease[J]. J Res Med Sci, 2017, 22: 62. PMID: 28616049. PMCID: PMC5461589. DOI: 10.4103/jrms.JRMS_1088_15.
14 Autilio C, Echaide M, Shankar-Aguilera S, et al. Surfactant injury in the early phase of severe meconium aspiration syndrome[J]. Am J Respir Cell Mol Biol, 2020, 63(3): 327-337. PMID: 32348683. DOI: 10.1165/rcmb.2019-0413OC.
15 Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome[J]. Int J Pediatr, 2012, 2012: 359571. PMID: 22164183. PMCID: PMC3228378. DOI: 10.1155/2012/359571.
16 陈扬, 陆国平. 儿童急性呼吸窘迫综合征的诊治进展[J]. 中国当代儿科杂志, 2018, 20(9): 717-723. PMID: 30210022. PMCID: PMC7389174. DOI: 10.7499/j.issn.1008-8830.2018.09.005.
17 Hao LX, Wang F. Effectiveness of high-frequency oscillatory ventilation for the treatment of neonatal meconium aspiration syndrome[J]. Medicine (Baltimore), 2019, 98(43): e17622. PMID: 31651876. PMCID: PMC6824716. DOI: 10.1097/MD.0000000000017622.
18 Yarci E, Canpolat FE. Evaluation of morbidities and complications of neonatal intensive care unit patients with respiratory disorders at different gestational ages[J]. Am J Perinatol, 2021. PMID: 33517566. Epub ahead of print. DOI: 10.1055/s-0041-1722942.
19 中华医学会儿科学分会新生儿学组, 《中华儿科杂志》编辑委员会. 新生儿肺动脉高压诊治专家共识[J]. 中华儿科杂志, 2017, 55(3): 163-168. PMID: 28273698. DOI: 10.3760/cma.j.issn.0578-1310.2017.03.002.
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