Risk Factors of Neonatal Death in Meconium Aspiration Syndrome at Pathum Thani Hospital-ปัจจัยเสี่ยงต่อการเสียชีวิตของทารกที่มีภาวะสูดสำลักขี้เทาในโรงพยาบาลปทุมธานี

บทคัดย่อ

           Meconium Aspiration Syndrome (MAS) is a common neonatal problem, severe complications and a cause of death in neonate. A study was performed to identify incidence, the risk factors of neonatal death and complications in 94 meconium aspiration syndrome neonates.

           A retrospective chart - review study of meconium aspiration syndrome neonate was conducted between 1 October 2005 and 30 September 2007. Inclusion criteria included; 1) history of meconium - stained amniotic fluid. 2) meconium in trachea from trachel suction at birth 3) respiratory distress 4) abnormal chest x-ray. Some patients even with the inclusion criteria of only 1,2 and 3 or 1,3 and 4 were also included in this study. In data analysis,descriptive statistic, chi-square test,Cochran’s and Mantel - Haenszel and binary logistic regression were employed. Meconium aspiration syndrome occurred in 0.95 percent of the total live birth or 16.02 percent of meconium - stained
amniotic fluid. Risk factors significantly associated with neonatal death in meconium aspiration syndrome were persistant pulmonary hypertenstion of newborn (PPHN) (p = 0.00, OR = 89.14, 95%CI 9.70-819.16), 5 minute Apgar score less than 7, (p = 0.00, OR = 33.02, 95%CI 1.53-41.84),1 minute Apgar score less than 7 (p = 0.00, OR =10.56, 95%CI 2.39-46.62) and pneumothorax (p =0.05, OR = 8, 95%CI 1.53-41.84). Logistic regression analysis showed only PPHN as a risk factor (OR 48.72, 95%CI 4.37-542.80). Pneumonia was the most common complication (23.04%), followed by sepsis (20.21%), PPHN (15.96%), seizure (11.70%), and pneumothorax (8.51%). The most serious complication was PPHN. The risk factors of neonatal death in meconium aspiration syndrome were PPHN, 5 minute Apgar score less than 7, 1 minute Apgar score less than 7 and pneumothaorax. PPHN was the most serious complication. Appropriate antenatal and postnatal management guideline should be established and emphasized by the co-operation between obstatic and pediatric department to decrease morbidity and mortality of meconium aspiration sydrome in infant.

Key words: meconium aspiration syndrome, risk fators, neonatal death