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Downloaded from fn.bmj.com on February 11, 2010 - Published by group.bmj.com

Meconium-stained amniotic fluid: discharge vigorous newborns
Y van Ierland, M de Boer and A J de Beaufort Arch Dis Child Fetal Neonatal Ed 2010 95: F69-F71 originally published online April 23, 2009

doi: 10.1136/adc.2008.150425

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Short report

Meconium-stained amniotic fluid: discharge vigorous newborns
Y van Ierland, M de Boer, A J de Beaufort
Division of Neonatology, Juliana Children’s Hospital, TheHague, The Netherlands Correspondence to: Dr Y van Ierland, Erasmus MC/ Sophia Children’s Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands; y.vanierland@ erasmusmc.nl Accepted 5 April 2009 Published Online First 23 April 2009

ABSTRACT Background: Most infants born through meconiumstained amniotic fluid (MSAF) are observed clinically for 24 h postnatally. Only 5% of infants born throughMSAF develop the meconium aspiration syndrome (MAS), a serious condition requiring medical intervention. Objective: To evaluate the value of 24-h postnatal observation of infants born through MSAF. Methods: A cohort of 394 term neonates born through MSAF was studied. Data were collected on Apgar scores, the development of MAS and other perinatal factors. Results: Nineteen of the 394 (4.8%) infantsborn through MSAF developed MAS. 298 (76%) infants had a 5-minute Apgar score (59AS) of >9. In this group the number of infants developing MAS (1; 0.3%) was significantly lower compared with the 59AS (8 group (18; 19%). Conclusion: MAS develops rarely in infants born through MSAF with 59AS above 8. These infants can be safely discharged from the hospital shortly after birth.
One in every sevenpregnancies ends with meconium-stained amniotic fluid (MSAF). MSAF can be harmful to the (unborn) infant with short and long-term sequelae. The meconium aspiration syndrome (MAS), a serious condition characterised by respiratory distress, pulmonary inflammation and hypoxaemia, develops in 2.7 to 5.4% of infants born through MSAF. MAS-related mortality is 5%.1 2 Because of the potential risks,paediatricians are commonly present at the time of delivery of newborns born through MSAF. Several factors, eg, abnormal fetal heart rate, Caesarean delivery, thick MSAF, male gender, low Apgar scores and the presence of meconium below the vocal cords have been associated with an increased risk of developing MAS.1–3 However, the prediction of which infants born through MSAF will or will not develop MAS,is difficult. Therefore, these infants are clinically observed during the first 24 h after birth in many countries worldwide, including The Netherlands. As most of these newborns are healthy and remain asymptomatic, we hypothesised that infants born through MSAF with a 5minute Apgar score (59AS) of 9 or 10 can be safely discharged from the hospital without a 24-h postnatal observation. The aim ofthis study was to evaluate the value of a 24-h postnatal hospital observation of infants born through MSAF.

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One out of every seven pregnancies ends with MSAF and 5% of the infants born through MSAF will develop MAS. Abnormal fetal heart rate, Caesarean delivery, thick MSAF, fetal acidaemia, low Apgar scores and the presence of meconium...
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