Risk Factors For Prognosis Of Neonatal Severe Meconium Aspiration Syndrome Treated By Mechanical Ventilation

Objective To explore the risk factors affecting the prognosis of neonatal severe meconium aspiration syndrome（MAS）treated by mechanical ventilation,and to analyze the predictive value of these factors,so as to provide help for improving the level of rescue and treatment of MAS,so as to reduce the mortality of neonatal with MAS.Methods The clinical data of our hospital 77 severe MAS children treated by mechanical ventilation from January 2014 to January 2020 were retrospectively analyzed,according to the treatment results,the patients were divided into successful treatment group（n=53）and failure treatment group（n=24）.The general clinical data、arterial blood gas analysis values、the use of pulmonary surfactant（PS）and its complications were analyzed and compared,then the multivariate stepwise Logistic regression analysis and the receive operating characteristic（ROC）curve were carried out to analysis the statistically significant observation indexesResults The prognosis of severe MAS treated by mechanical ventilation was not related to gestational age,age,birth weight,sex and delivery mode（P>0.05）,the use rate of mechanical ventilation combined with PS endotracheal dripping in the successful group was higher than that in the failure group,the difference was statistically significant（P<0.05）.The incidence of intrauterine distress,persistent pulmonary hypertension（PPHN）and multiple organ dysfunction（MODS）in the failed group were 66.7%,41.7%and 66.7%respectively,which were higher than those in successful group（45.5%,5.7%,22.6%）,and the difference was statistically significant（P>0.05）,while the incidence of hypoxic-ischemis encephalopathy（HIE）,acute respiratory distress syndrome（ARDS）and neonatal pulmonary hemorrhage（PPHN）were not significantly different between the two groups（P<0.05）.The score of 1 min and 5 min Apgar,p H value,arterial partial pressure of oxygen（Pa O₂）and base excess（BE）in the treatment failure group were significantly lower than those in the successful group,and the difference was statistically significant（P<0.05）.Multivariate logistic regression analysis showed that Pa O₂,BE value,PPHN and MODS were independent risk factors for the prognosis of severe MAS treated by mechanical ventilation.The area under the receive operating characteristic curve of BE value predicting of severe MAS was 0.713（95%confidence interval:0.558-0.867,P<0.05）at the cut-off-8.5,the sensitivity and specificity were 94.3%and 58.3%,respectively;The area under the receive operating characteristic curve of Pa O₂predicting of severe MAS was 0.726（95%confidence interval:0.559-0.853,P<0.05）at the cut-off 40.5mm Hg（1mm Hg=0.133k Pa）,the sensitivity and specificity were79.2%and 58.3%,respectively.Conclusion Fetal intrauterine distress,acidosis and Apgar score are associated with poor prognosis of severe MAS.Mechanical ventilation combined with endotracheal drip of PS is beneficial to the treatment of severe MAS,but it is not an independent risk factor affecting prognosis.Pa O₂,BE values and complication PPHN and MODS are independent risk factors affecting the prognosis of sever MAS treated by mechanical ventilation.Pa O₂and BE values can predict the prognosis of severe MAS,and early and timely prevention and treatment of these risk factors can reduce the mortality of severe MAS.