Evaluation of neonatal sepsis screening in a tropical area. Part III: neonatal sepsis in meconium stained deliveries

Of the 6,060 consecutive live births delivered at the University Maternity Unit of Guadeloupe (French West Indies) during a 30-month period, 635 newborns (10.4 percent) presented with meconium stained (MS) amniotic fluid, of which 595 (94 percent) received bacteriological screening at birth (light MS, n=543; thick MS, n=52). Thirty (5 percent) of MS newborn had a bacteraemia (n=13, group B streptococcus, GBS), and 128 (21.5 percent) a bacterial positive gastric aspirate (n=54, GBS). Sixty-six newborns among MS babies needed tracheal suctioning (11 percent) in the delivery room for meconium inhalation. Among these 595 screening MS newborn, 286 (48 percent) presented clinical signs of postmaturity of birth, having therefore an explanation for their MS condition. For the other MS newborn without the postmaturity explanation, we experienced twofold increased risk of neonatal sepsis (OR 1.88 for bacteraemia and 2.61 for external carriage p < 0.02, Chi square) as compared with their MS postmature counterparts. We conclude that when meconium stained deliveries are associated with postmaturity signs, one may not need to initiate prophylactic antibiotic treatment at birth unless they present with other traditional risk factros for neonatal sepsis such as intrapartum fever and prolonged rupture of membranes.(Au)

Characteristics of babies born through meconium-stained liquor - abstract

Antepartum passage of meconium remains a common perinatal problem in the Caribbean, and the purpose of this study was to compare maternal, obstetric and neonatal characteristics of babies born with and without meconium-stained liquor (MSL). The medical records of 4093 of 5397 live births (76 percent) at the Mount Hope Women's Hospital (MHWH) during 1991 were reviewed, and relevant data were collected and analyzed, using an Epi-Info software programme. Meconium staining of the amniotic fluid (MSL) was present in 458 live births, giving a prevalence of 11.2 percent of live births which is comparable to values reported in other studies. MSL was more common in mothers of African than East Indian origin. The mean ages of women with and without MSL were similar (26.3 ñ S.D. 5.90 and 25.53 ñ 5.98 years, respectively). The 3 commonest maternal problems in the 458 women with MSL were foetal distress (20.7 percent), hypertension in pregnancy (14.0 percent) and postdatism (10.9 percent), all of which were significantly more common than in women without MSL. Babies born through MSL were significantly heavier at birth 93263 ñ 514 vs 3008 ñ 625 gm). Preterm was less common (2.2 percent vs 13.6 percent) and post-term more common (10.7 percent vs 3.1 percent) in babies born through MSL. Asphyxia at 1 and 5 minutes was more common in babies born through MSL. Neonatal problems were encountered in about one-third of babies with and without MSL. Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (3.3 percent) to give an incidence of 3.7/1000 live births. There were 73 deaths among the 4093 live births to give a crude mortality rate of 1.8 percent as compared to a rate of 0.9 percent for babies born through MSL (AU)

Perinatal implications of meconium stained liquor

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital(MHWH), Trinidad, during the period January 1 to December 31, 1991.The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium staining of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using EPI-INFO software programme. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years within a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress(23.9 percent), hypertension in pregnancy(14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 4,960g with a mean of 3,258g, 8 percent were <2,500g and 9.8 percent were >/_4,000g. 86.3 percent were term 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 percent were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicated the need for improvement in the delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment (AU)

Perinatal implications of meconium stained liquor

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital (MHWH), Trinidad, during the period January 1 to December 31, 1991. The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium staining of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analyzed using Epi-Info software programme. The findings clearly indicate the need for improvement in delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment(AU)

Perinatal implications of meconium stained liquor: The Third Ester Archer Memorial Lecture

Antepartum passage of meconium remains a common perinatal problem in the Caribbean and the purpose of this study was to examine this problem in all babies born at the Mount Hope Women's Hospital (MHWH), Trinidad during the period January 1 to December 31, 1991. The medical records of all 5,397 live births at the MHWH during the study period were retrospectively reviewed. Those with meconium of the amniotic fluid (graded as slight or old and thick) were identified both by using the ICD code and by examination of the medical records. Maternal, perinatal and neonatal data were collected and analysed using Epi-Info software. Meconium staining of the amniotic fluid was present in 336 live births, giving a prevalence of 6.2 percent of live births which is low compared to values reported in other studies. There was no significant ethnic differences among women who had MSL and 81.3 percent were aged <32 years with a mean of 26.4 years. The majority were primiparous (46.4 percent) and 97 percent had antenatal care. The 3 commonest maternal problems in the 336 women with MSL were foetal distress (23.9 percent), hypertension in pregnancy (14.9 percent) and postdatism (10.4 percent). Birth weight of babies ranged from 1,040 to 4,960 g with a mean of 3,258 g, 8 percent were <2,500 and 9.8 percent were >4,000 g. 86.3 percent were term, 10.7 percent were post-term and 3.0 percent were preterm. One and 5 minute Apgar scores of <7 were found in 45.5 percent and 12.2 percent of babies, respectively. Neonatal problems were encountered in 146/336 neonates (43.8 percent) and respiratory distress was the commonest (72 or 49.3 percent). Meconium aspiration syndrome (MAS) was diagnosed in 15 babies (4.5 percent) to give an incidence of 2.8/1000 live births and was associated only with the presence of old and thick meconium in the amniotic fluid. There were 6 (40 percent) deaths among the 15 with MAS. These findings clearly indicate the need for improvement in delivery room management of mother and foetus and early neonatal care. These needs can be met through an increase in staff complement, regular in-service training and an adequate supply of consumables and proper planned maintenance of equipment. (AU)