| Backgrounds and Objectives: Meconium aspiration syndrome(MAS)or meconium aspiration pneumonia that is caused by the fetus expelling meconium to contaminate the amniotic fluid in the mother’s body and inhaling a certain amount of meconium-contaminated amniotic fluid before or during delivery which lead to mechanical airway obstruction,the dysfunction of pulmonary surfactant(PS)and inflammation of lung tissue.The main symptoms is respiratory distress,manifested as cyanosis,moan,shortness of breath,nasal flapping,etc.after birth,accompanying by damage to other organs and systems.Compared with premature babies,term babies and overdue babies are more common.The first condition for the occurrence of MAS is the presence of meconium contamination of amniotic fluid(MSAF).The incidence of MSAF increases with gestational age(GA).The incidence of MSAF is more than 30% in GA>42 weeks;the incidence in GA<37 weeks is <2%;in GA<34 weeks,meconium is rarely excreted into amniotic fluid.Although perinatal medicine has made great progress in recent years,the incidence of MAS and the resulting mortality in children are still relatively high,and it is one of the main causes of neonatal death.Through literature review,it is found that there are relatively few studies on the influencing factors of MAS and the influencing factors of MAS in different severity levels in China,so this study provides a realistic possibility.Part Ⅰ Analysis of the influencing factors of MASObjectives: Through the analysis of the clinical data of 291 full-term children with meconium-stained amniotic fluid in the Department of Neonatology,the First Affiliated Hospital of Dali University from January 2018 to November 2020,to study the influencing factors of MAS in term infants.Methods: By retrospectively analysis,the clinical data of 291 full-term children with meconium-stained amniotic fluid in the Department of Neonatology,the First Affiliated Hospital of Dali University from January 2018 to November 2020 were collected.Taked the occurrence of MAS as the grouping variable,the children were divided into the non-MAS group(174 cases)and the MAS group(117 cases).The variables from the pregnant mother such as parity,delivery mode,etc.and the variables from the child such as gestational age,gender,birth weight,etc.were analyzed.Through statistical analysis,the factors related to the occurrence of MAS were obtained.Result: 1.Among the 291 full-term children with meconium-stained amniotic fluid,there were 174 cases in the non-MAS group and 117 cases in the MAS group.The incidence of MAS was 40.2%.2.The occurrence of MAS was related to gestational age.The average gestational age in the MAS group was 40.0±1.00 w,which was higher than the average gestational age of 39.1±1.13 w in the non-MAS group,and the difference was statistically significant(P<0.05).The incidence of MAS increased with the gestational age.3.The occurrence of MAS was significantly correlated with the scale of amniotic fluid pollution(P<0.05),and it was positively correlated with the degree of pollution.There were 291 cases of children with meconium-contaminated amniotic fluid.Among them,there were 73 cases of amniotic fluid pollution of degree I,1 case of MAS occurred,and the incidence of MAS was 1.4%;44 cases of amniotic fluid pollution of degree II,9 cases of MAS occurred,and the incidence of MAS was 20.5%;174 cases of amniotic fluid pollution of degree III,107 cases of MAS occurred,and the incidence of MAS was 61.5%.In the MAS group,the mainly meconium-contaminated amniotic fluid was degree III.There were 107 cases,accounting for 91.5%(107/117).4.The occurrence of MAS was related to cesarean section.In the non-MAS group and the MAS group,there were 63 cases(36.2%,63/174)and 65 cases(55.6%,65/117)of cesarean section respectively.The rate of cesarean section in the MAS group was higher than that in the non-MAS group,and the difference was statistically significant(P<0.05).5.The occurrence of MAS was related to the arterial pH at admission.The average arterial pH at admission of the MAS group was 7.28±0.03,which was lower than the average arterial pH at admission of 7.32±0.06 in the non-MAS group.The difference was statistically significant(P<0.05).6.The occurrence of MAS was related to Apgar score.The Apgar scores in the MAS group were 5.84±1.46,6.97±1.22,8.51±1.00,and the Apgar scores in the non-MAS group were 8.55±0.85,9.68±0.58,9.87±0.37.The Apgar score of the MAS group was lower than the non-MAS group,and the difference was statistically significant(P<0.05).7.The occurrence of MAS was not related to gender,birth weight,parity,presence or absence of umbilical cord abnormalities,premature rupture of membranes,and placental abnormalities,arterial BE value at admission.The difference was not statistically significant(P>0.05).Conclusion: 1.The occurrence of MAS is related to the gestational age,the scale of amniotic fluid pollution,cesarean section,the arterial pH at admission and the Apgar score.2.Gender,birth weight,parity,presence or absence of umbilical cord abnormalities,premature rupture of membranes,and placental abnormalities,arterial BE value at admission have no significant correlation with the occurrence of MAS,that is,they are not the factors influencing the occurrence of MAS.3.Gestational age,cesarean section,scale of amniotic fluid pollution,arterial pH at admission are independent risk factors for the occurrence of MAS,and Apgar score is an independent protective factor for the occurrence of MAS.Part Ⅱ Analysis of the influencing factors of mild,moderate and severe MASObjectives: The MAS group(117 cases)is divided into three groups according to the severity of the disease,and the comparison between the two groups are the mild group vs the moderate group,the mild group vs the severe group,and the moderate group vs the severe group.To analyze the influencing factors of mild,moderate,severe MAS.Methods: By retrospectively analysis,the clinical data of 117 full-term children with confirmed MAS in the Department of Neonatology,the First Affiliated Hospital of Dali University from January 2018 to November 2020 were collected.According to the severity of the disease,the children were divided into three groups: mild,moderate and severe.The comparison between the two groups were the mild group vs the moderate group,the mild group vs the severe group,and the moderate group vs the severe group.The variables from the pregnant mother such as parity,delivery mode,etc.and the variables from the child such as gestational age,gender,birth weight,etc.were statistically analyzed among the three groups,and then the influencing factors of mild,moderate and severe MAS were obtained.Result: 1.The difference of Apgar score among the three groups of mild,moderate and severe MAS was statistically significant,that was,P<0.05.The Apgar scores of the mild group were 7.47±0.86,8.07±0.87,9.03±0.49;the Apgar scores of the moderate group were 5.83±0.85,6.97±0.89,8.58±0.77;the Apgar scores of the severe group were 4.11±0.88,5.79± 1.07,7.82±1.39.As the severity of MAS got worse,the score decreased.2.The Arterial pH at admission was statistically significant among the three groups of mild,moderate and severe MAS,that was,P<0.05.The average arterial pH at admission of the mild group was 7.32±0.02,the average arterial pH at admission of the moderate group was 7.28±0.01,and the average arterial pH at admission of the severe group was 7.25±0.02.As the condition of MAS worsened,the Arterial pH at admission also decreased.3.In the MAS group,the mainly meconium-contaminated amniotic fluid was degree III,accounting for 91.5%(107/117),So the difference among the three groups was not obvious.There was no significant difference in amniotic fluid pollution grades among the three groups of mild,moderate and severe MAS,that was,P>0.05.4.The severity of MAS had nothing to do with gestational age and the mode of delivery.Conclusion: 1.There is no statistically significant difference in the scales of amniotic fluid pollution among the three groups of mild,moderate and severe MAS,that is,P>0.05.2.The difference of Apgar score among the three groups of mild,moderate and severe MAS is statistically significant,that is,P<0.05.As the severity of MAS gets worse,the score decreases.3.The Arterial pH at admission is statistically significant among the three groups of mild,moderate and severe MAS,that is,P<0.05.As the condition of MAS worsens,the Arterial pH at admission also decreases. |
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