Meconium aspiration syndrome: have we made a difference?

Meconium aspiration syndrome (MAS) and its associated complications are reviewed from the period before the routine use of intubation and suctioning to the present (1973 through 1987). Of the 176,790 neonates born during this period, the amniotic fluid was stained in 21,472 (12.15%). Subsequently, MAS developed in 1162 (5.41%) of the meconium-stained neonates. Male neonates were more prone to the disorder than female neonates (P = .022). There were no racial predilections for MAS. The incidence of MAS significantly decreased during the 15 years (P = .043). Of the neonates with MAS, 49 (4.22%) died as a direct consequence of the disorder. The death rate significantly declined during the study period (P = .041). Of the neonates with MAS, 345 (29.7%) required mechanical ventilation, and 134 (11.53%) had pneumothoraxes. Among neonates with MAS, the requirement for mechanical ventilation, as well as the incidence of pneumothoraxes, did not decrease from 1973 through 1987. The incidence of MAS has declined since the advent of combined obstetric and pediatric suctioning of the oropharynx and trachea. Furthermore, there are significantly fewer deaths from the disorder. These declines were likely influenced by other improvements in perinatal care, which have occurred since the early 1970s. The results do not support the contention that severe MAS and resultant deaths can be prevented altogether.

Management of asymptomatic, term gestation neonates born to mothers treated with intrapartum antibiotics.

Intrapartum antibiotics are frequently administered to parturient women for suspected chorioamnionitis to treat infection in the mother and to prevent or treat infection in the baby. We sent a questionnaire to the 150 United States fellowship program directors in neonatology and pediatric infectious disease, focusing on recommendations for evaluation and therapy of apparently healthy, pretreated, term gestation infants. Eighty-three (55%) of the completed responses were analyzed. Sixteen (19%) respondents do no initial laboratory evaluation but simply observe the baby, 65 (78%) take a complete blood count as well as a platelet count, 59 (71%) obtain blood cultures, 41 (49%) check urine antigen for Group B Streptococcus (GBS) and 23 (28%) perform a lumbar puncture. Only 39% of respondents would begin antibiotic therapy for all pretreated infants. If the evaluation were unremarkable 65 directors would treat for less than or equal to 3 days. If only the urine GBS antigen were positive 47 would treat for greater than or equal to 7 days, while if an elevated immature neutrophil:total neutrophil ratio were the sole abnormality 19 would treat for greater than or equal to 7 days. Forty-four respondents thought that a combination of an elevated immature neutrophil:total neutrophil ratio and a positive urine GBS antigen should always be considered indicative of bacteremia. Given a different scenario, that of a mother treated with intrapartum antibiotics because of a positive cervical culture for GBS and a risk factor (e.g. temperature greater than or equal to 38 degrees C), 58 respondents would begin antibiotics. There is no consensus regarding management of pretreated, healthy appearing, term gestation neonates.