Risk Factors and Predictors of Mechanical Ventilation in Neonates With Meconium Aspiration Syndrome: A Retrospective Study at King Salman Armed Forces Hospital, Tabuk, Saudi Arabia

Abstract

Background Meconium aspiration syndrome (MAS) is a critical neonatal condition predominantly associated with term and post-term pregnancies, characterized by the aspiration of meconium-stained amniotic fluid (MSAF) leading to severe respiratory distress. Despite advances in obstetric and neonatal care, MAS remains a significant cause of neonatal morbidity, particularly in settings with limited access to advanced neonatal care. Objectives This study aimed to evaluate the prevalence of mechanical ventilation and explore potential predictors for respiratory support in neonates diagnosed with MAS at King Salman Armed Forces Hospital (KSAFH) in Tabuk, Saudi Arabia, from 2020 to 2024. Methods A retrospective cross-sectional analysis was conducted on 329 full-term and post-term neonates diagnosed with MAS. Data were extracted from medical records, including demographic details, clinical characteristics, treatment modalities, and outcomes. Statistical analyses were performed to identify correlations between these variables and the need for mechanical ventilation. Results The study revealed a slight male predominance (193, 58.7%) among neonates with MAS, with a mean gestational age of 39 weeks and a mean birth weight of 3.19 kg (SD = 1.67). A significant association was observed between cesarean section (CS) deliveries and the administration of surfactant therapy (p = 0.019). Mechanical ventilation was required in 30 (9.1%) of the neonates, with seven (2.1%) requiring high-frequency oscillatory ventilation (HFOV). The most common pregnancy complication associated with MAS was a non-reassuring fetal heart rate, affecting 162 (49.2%) of cases. However, no significant associations were found between maternal medical history, pregnancy complications, and the need for mechanical ventilation. The average neonatal intensive care unit (NICU) stay was 5.33 days (SD = 4.37), with persistent pulmonary hypertension of the newborn (PPHN) observed in 14 (4.3%) of cases. Conclusions MAS remains a challenging condition in neonatal care, with significant respiratory morbidity necessitating advanced respiratory support. The study underscores the importance of tailored management strategies, particularly in neonates delivered via CS. Further research is needed to refine treatment protocols and improve long-term outcomes for neonates with MAS.

Keywords: cesarean section; mechanical ventilation; meconium aspiration syndrome; meconium-stained amniotic fluid; neonatal respiratory distress; persistent pulmonary hypertension of the newborn; surfactant therapy.

Figure 1. Pregnancy Complications in Neonates With Meconium Aspiration Syndrome (MAS)

Bar chart displaying the frequency of specific pregnancy complications in mothers of neonates diagnosed with MAS, including non-reassuring heart rate, perinatal asphyxia, and oligohydramnios.

Figure 2. Distribution of Maternal History in Neonates With Meconium Aspiration Syndrome (MAS)

Bar chart illustrating the frequency of maternal medical conditions in neonates diagnosed with MAS. Conditions include maternal diabetes mellitus (DM), hypothyroidism, asthma, protein S deficiency, maternal hypertension, and maternal infection (chorioamnionitis).