Meconium aspiration in neonates: combined obstetric and paediatric intervention improves outcome.
All meconium aspiration syndrome cases admitted in the two neonatal units were compared to evaluate the antenatal and natal events including resuscitative measures and outcome of neonates and to confirm the beneficial effects of immediate combined obstetric and paediatric intervention on morbidity and mortality. Neonates managed in nursery at Mayo Hospital (Group 1, n = 44) were delivered at other hospitals and birth centres, underwent resuscitation by obstetricians and/or anaesthetists and then referred. Neonates admitted in the neonatal unit of Lady Willingdon Hospital (Group 2, n = 48) were inborn and resuscitated by paediatric residents. Both groups were comparable for weight, sex, booked status, maturity, history of prolonged labour, fetal distress and Apgar score at 5 minutes. Significant differences were proportion of C-section (62% in Gp 2 v 34% in Gp1), laryngoscopy and tracheal intubation (100% in Gp 2 v 9% in Gp1), time of arrival in the nursery (mean 0.14 hr in Gp 2 v 3.91 hr in Gp 1), persistent cyanosis (43% in Gp 2 v 68% in Gp1), earlier start of feeding (mean 2.4 days in Gp 2 v 3.2 days in group 1) and shorter stay in hospital (2.87 days in Gp 2 v 5 days in Gp 1). 27% cases died in group 2 compared to 47% in group 1 (pvalue = 0.04). Combined immediate obstetric intervention (C-section) and paediatric intervention (laryngoscopy, tracheal intubation, suction, immediate transfer to nursery) led to reduced severity of meconium aspiration syndrome and lower mortality.