Management and Follow-Up of a Cohort of Neonates With Meconium Aspiration Syndrome Before and After the Revision of the 2015 Neonatal Resuscitation Program.

INTRODUCTION: Meconium aspiration syndrome (MAS) is a respiratory condition associated with high morbimortality. Standards of care changed over the years addressing its specificities, aiming to decrease poor respiratory and neurologic long-term outcomes. This study aims to compare the practice and outcomes of MAS in a level III neonatal intensive care unit before and after the revision of the 2015 Neonatal Resuscitation Program (NRP).

METHODS: A 15-year retrospective cohort of patients with MAS was assessed regarding perinatal management, clinical outcome, and neurodevelopmental follow-up.

RESULTS: A total of 52 MAS occurred, 51.9% (n=27) male gender, median gestational age 40 weeks (IQR 39-40), and mean birth weight of 3395±503 g. Recommendations of the NRP were implemented with a significant change in the management in the delivery room, as positive pressure ventilation was more frequent (p=0.001). No significant change was found in the clinical span or morbidity of MAS after NRP, except for lower acidosis (pH 7.0 vs. 7.2; p=0.042) and lower hyperlactatemia (12.2 vs. 6.4 mmol/l; p=0.035). Overall acute complications included pulmonary hypertension (21.2%, n=11) and pneumothorax (15.4%, n=8). To date, morbidity during follow-up didn't differ after NRP concerning global development delay (p=0.591), neurologic sequelae (p=0.276), and recurrent bronchospasm (p=0.614), in contrast with speech delay, which was less frequent in the later subgroup (p=0.023).

CONCLUSIONS: SAM persists as a concerning condition. From our data, the NRP showed no inferiority in the clinical outcomes, consistent with the literature but with higher frequency. Late morbidity is still a problem concerning cerebral palsy and global development delay, similar to known data.