Effect Of Dexamethasone In The Outcome Of Meconium Aspiration Syndrome: A Prospective Study

Abstract

BACKGROUND AND OBJECTIVE Meconium aspiration syndrome (MAS) is an important cause of respiratory distress in term and post- term newborn babies. The overall frequency of MAS varies between 5-25% (median 14%). It occurs in around 10% of babies born through meconium stained amniotic fluid (MSAF). The pathophysiology of MAS is not completely understood. Meconium aspiration leads to activation of pulmonary macrophages producing an intense inflammatory response and infiltrations of polymorphonuclear lymphocytes diffusely through the lungs. Since inflammation plays an important role in the pathophysiology of MAS, suppression of inflammation by corticosteroids appears to be of potential benefit. Hence the present study is intended to assess the effect of Dexamethasone administration in the outcome of meconium aspiration syndrome.

METHODS A late preterm (34 – 36 weeks), term and postterm babies born with meconium stained amniotic fluid with respiratory distress were included in the study. The neonates were made into two groups, case group with steroid therapy along with routine treatment of MAS and control group only with routine treatment of MAS. The severity of respiratory distress was assessed by Downe‘s scoring system. Recording of weight, vitals, RBS, SPO2, serum electrolytes (sodium, potassium, xii calcium, chloride), sepsis screening including total leucocyte count, C-reactive protein, band neutrophil ratio and blood culture were recorded at the time of admission in both the groups. X – ray chest was done routinely on admission. In case group intravenous dexamethasone was administered. The first dose was given starting from 2nd day of life (i.e 24hr to 36hrs) and given for another two days. In control group only routine treatment of MAS was given. Period of oxygen dependency, duration of hospital stay, initiation of feeds, development of sepsis were assessed in both the groups. RESULTS 70 neonates were included in the study, 34 neonates in case group and 36 neonates in control group. Clinical profile, period of oxygen dependency, hospital stay and initiation of feeds were similar in both the groups. No serious adverse effects were noted in steroid treated group (case group).

CONCLUSION In our study we found that there was no significant difference in terms of oxygen dependency, duration of hospital stay and morbidity and mortality in between the steroid treated group and the control group. A further large randomised control trial is needed to study the effect of steroid in the outcome of meconium aspiration syndrome.