PC1046: The Perinatal Risk Factors Affecting the Newborn Resuscitation in Meconium-stained Deliveries

Background: The presence of meconium-stained amniotic fluid (MSAF) is considered a significant perinatal risk factor that increases the likelihood that the newborn will require resuscitation in the delivery room. Even though the routine intubation and suctioning of meconium-stained newborns is not recommended, the American Heart Association 2020 guidelines suggest that a neonatal team trained in advanced resuscitation is readily available to attend these deliveries especially when additional risk factors are present. However, these risk factors are not clearly defined. The purpose of this study is to identify the additional risk factors that increase the odds of a meconium-stained newborn needing resuscitation.

Methods: This is a multicenter retrospective cohort study. Chart reviews were performed of the deliveries associated with MSAF between January 1, 2017 to December 31, 2019. Resuscitation was defined as the newborn needing any intervention in addition to the initial routine steps such as providing warmth, drying, positioning and clearing upper airway when needed. Resuscitation efforts included oropharyngeal suctioning of meconium with a catheter, free flow oxygen, continuous positive airway pressure, positive pressure ventilation, intubation, endotracheal suctioning, chest compressions, and/or medications. The newborns needing resuscitation were compared to those not needing resuscitation. Among them, the newborns needing advanced resuscitation were compared to those not needing advanced resuscitation. Advanced resuscitation was defined as the newborn needing any intervention in addition to the initial routine steps, oropharyngeal suctioning with catheter, and/or free flow oxygen. Interventions for advanced resuscitation included continuous positive airway pressure, positive pressure ventilation, intubation, endotracheal suctioning, chest compressions, and/or medications. Logistic regression analysis was performed to define the perinatal factors which significantly increased the odds of needing resuscitation or advanced resuscitation.

Results: Out of 2213 infants born via MSAF, only 491 (22.2%) needed resuscitation and 151 (7%) needed advanced resuscitation. Utilizing logistic regression analysis, we assessed the perinatal factors affecting the resuscitation of the newborn in the delivery room. Primigravida, thick meconium, fetal distress, chorioamnionitis, rupture of membranes ≥ 18 hours, post-term (gestational age > 42 weeks), cesarean section or shoulder dystocia significantly increased the odds of a meconium-stained newborn needing resuscitation (Table 1). Fetal distress, chorioamnionitis and cesarean section increased the odds of needing advanced resuscitation (Table 2). The perinatal factors associated with significantly decreased odds of needing resuscitation and advanced resuscitation were vaginal delivery and delayed cord clamping (Tables 1 and 2).

Conclusion: By knowing the perinatal risk factors affecting the newborn intervention in the delivery room the neonatal teams can be appropriately prioritized and optimally utilized in the deliveries associated with MSAF.