• Resuscitation · Apr 2023

    Perinatal Risk Factors Associated with the Need for Resuscitation in Newborns Born Through Meconium-Stained Amniotic Fluid.

    • Arpitha Chiruvolu, Samantha Fine, Kimberly K Miklis, and Sujata Desai.
    • Division of Neonatology, Department of Pediatrics, Baylor University Medical Center, Baylor Scott & White Health, Pediatrix Medical Group, Dallas, TX, USA; Department of Medical Education, Texas A&M University College of Medicine, Bryan, TX, USA. Electronic address: Arpitha.Chiruvolu@bswhealth.org.
    • Resuscitation. 2023 Apr 1; 185: 109728109728.

    ObjectiveThe Neonatal Life Support 2020 guidelines emphasize that meconium-stained amniotic fluid (MSAF) remains a significant risk factor for a newborn to receive advanced resuscitation, especially if additional risk factors are present at the time of birth. However, these additional perinatal risk factors are not clearly identified. The purpose of this study was to evaluate the importance of additional independent ante- and intrapartum risk factors in the era of no routine endotracheal suctioning that determine the need for resuscitation in newborns born through MSAF.MethodsThis retrospective cohort study included deliveries ≥ 35 weeks' gestation associated with MSAF that occurred between January 1, 2017 and December 31, 2019. The newborns needing resuscitation (any intervention beyond the initial steps) were compared to those not needing resuscitation. Among newborns needing resuscitation, those needing advanced resuscitation (continuous positive airway pressure/ positive pressure ventilation or beyond) were compared to those not needing advanced resuscitation.ResultsLogistic regression analysis revealed that among various perinatal factors, primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age ≥ 42 weeks), cesarean section or shoulder dystocia independently significantly increased the odds of a meconium-stained newborn needing resuscitation. Among these factors, fetal distress, chorioamnionitis or cesarean section independently further increased the odds of needing advanced resuscitation.ConclusionRisk stratification of perinatal factors associated with the need for newborn resuscitation and advanced resuscitation in the deliveries associated with MSAF may help neonatal teams and resources to be appropriately prioritized and optimally utilized.Copyright © 2023 Elsevier B.V. All rights reserved.

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