Usta et al identified risk factors in neonates associated with the meconium aspiration syndrome. These factors are sensitive but not specific for identifying infants likely to be affected. The authors are from the University of Tennessee.
Factors predisposing to meconium aspiration:
(1) maternal history of previous cesarean section
(2) mother admitted for nonreassuring fetal heart tracing
(3) delivery by cesarean section
(4) Apgar score at 1 minute <= 4
(5) intubation of neonate with suctioning below the vocal cords
Factor protecting against meconium aspiration syndrome:
(1) maternal cigarette smoking
|
Factor |
Odds Ratio |
95% CI |
p value |
|
maternal history cesarean section |
2.5 |
1.1 – 5.4 |
0.02 |
|
nonreassuring fetal heart rate |
6.9 |
1.8 – 26.9 |
0.006 |
|
delivery by cesarean section |
3.0 |
1.4 – 6.4 |
0.004 |
|
Apgar at 1 minute <= 4 |
3.1 |
1.2 – 7.8 |
0.02 |
|
intubation with deep suctioning |
4.9 |
1.8 – 13.0 |
0.001 |
|
maternal cigarette smoking |
0.07 |
0.009 – 0.063 |
0.02 |
from Table 3, page 232
number of adverse risk factors present =
= SUM(number of predisposing factors present)
Interpretation:
• minimum number of adverse factors: 0
• maximum number of adverse factors: 5
• If none of the risk factors were present, then the risk of the meconium aspiration syndrome was very low.
If at least 1 adverse factor is present:
• sensitivity 92%; specificity 56%
• positive predictive value 8%; negative predictive value 99%
• About half the neonates in the study had 1 or more risk factors present, but only 1 in 11 of these infants developed the syndrome.
• Admission for nonreassuring fetal heart rate was the most specific finding (98%), but was relatively insensitive (13%)
Limitations:
• I did not see a discussion of how risk changed when more than 1 adverse factor was present.
Specialty: Pedatrics
ICD-10: ,
