Journal Information
Vol. 17. Issue 2.
Pages 71-76 (March - April 2011)
Vol. 17. Issue 2.
Pages 71-76 (March - April 2011)
Artigo original
Open Access
Síndrome de aspiração meconial - experiência de um centro terciário
Meconium aspiration syndrome - the experience of a tertiary center
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M.C. Espinheira, M. Grilo, G. Rocha
Corresponding author
gusrocha@oninet.pt

Autor para correspondência.
, B. Guedes, H. Guimarães
Serviço de Cuidados Intensivos Neonatais, Departamento de Pediatria. Hospital São João, Porto, Portugal
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Article information
Resumo
Introdução

Aproximadamente 5% dos recém-nascidos com evidência de mecónio no líquido amniótico desenvolvem a síndrome de aspiração meconial (SAM).

Objectivos

Conhecer os dados demográficos, a morbilidade e mortalidade na dependência da SAM e identificar possíveis factores de risco.

Métodos

: Estudo retrospectivo dos recém-nascidos com SAM nascidos num hospital terciário entre 1 de Janeiro de 1997 e 31 de Dezembro de 2008.

Resultados

A SAM foi responsável por 1,4% das admissões na Unidade de Cuidados Intensivos Neonatais (UCIN), verificando-se uma tendência para o decréscimo no número de internamentos ao longo dos anos, principalmente dos casos com líquido amniótico tingido de mecónio. No período de estudo foram analisados 72 recém-nascidos: 55,6% do sexo feminino, 62,5% com parto por cesariana, 93% com idade gestacional > 36 semanas e 91,2% com peso ao nascimento > 2500g. 69% dos recém-nascidos apresentaram Índice de Apgar < 7 no 1. ° minuto e 23,6% Índice de Apgar < 7 no 5.° minuto; bradicardia fetal foi observada em 26,4% dos recém-nascidos e taquicardia em 1,4%. A presença de mecónio no líquido amniótico condicionou o desenvolvimento de hipóxia (58,3%), necessidade de ventilação mecânica (43,1%), acidose respiratória e/ou metabólica (30,6%), hipertensão pulmonar (11,1%) e encefalopatia hipóxico-isquémica (29,2%). A taxa de mortalidade foi de 2,8%. A presença de mecónio espesso esteve associada a maiores taxas de morbilidade e mortalidade.

Conclusão

O número de internamentos por SAM tem vindo a diminuir principalmente devido ao decréscimo das admissões por líquido amniótico tingido de mecónio, enquanto o número de casos de mecónio espesso tem permanecido constante ao longo dos anos. O Índice de Apgar < 7 no 1. ° minuto e a presença de sinais de sofrimento fetal durante o trabalho de parto apresentaram relação com a SAM. A morbilidade associada à SAM permanece significativa.

Palavras-chave:
Síndrome de aspiração meconial
Factores de risco
Morbilidade
Mortalidade
Abstract
Background

Approximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS).

Aim

The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors.

Methods

Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1st, 1997 to December 31st, 2008.

Results

MAS was responsible for 1.4% of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6% (n=40) were of the female gender, 62.5% were delivered by caesarean section, 93% had > 36 weeks of gestational age and 91.2% had a birth weight over 2500g. Sixty-nine percent had an Apgar score < 7 at 1 minute and 23.6% an Apgar score < 7 at 5 minutes; foetal bradicardia was present in 26.4% of the newborns and tachycardia in 1.4%. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3%), need of mechanical ventilatory support (43.1%), respiratory and/or metabolic acidosis (30.6%), pulmonary hypertension (11.1%) and hypoxic ischemic encephalopathy (29.2%). The mortality rate was 2.8%. Thick meconium was associated with higher morbidity and mortality rates.

Conclusion

The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

Keywords:
Meconium aspiration syndrome
Risk factors
Morbidity
Mortality
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Copyright © 2011. Sociedade Portuguesa de Pneumologia
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