Masters Degrees ( Paediatric Surgery)

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    Outcomes of severe meconium aspiration syndrome in a resource restricted hospital, Cape Town, South Africa
    (Stellenbosch : Stellenbosch University, 2022-11) Busgeeth, Mohammad Asrafee Jameel; Van Wyk, Lizelle; Goussard, Pierre; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health.
    ENGLISH ABSTRACT: Background/Aim: Meconium aspiration syndrome (MAS) is defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAF) whose symptoms cannot be otherwise explained. Mortality and morbidities vary in different resourced health settings. This study aimed to describe the management strategies, short-term (in-hospital) outcomes and mortality of neonates with severe MAS (defined as those requiring invasive ventilation) at a resource restricted hospital in Cape Town, South Africa. Methodology: We performed a retrospective descriptive study of neonates requiring invasive ventilation for suspected MAS at Tygerberg hospital, Cape Town, South Africa between January 2016, and December 2018. Results: Ninety-two neonates with suspected MAS were included in the initial cohort, of which only 47 qualified based on the radiological findings (patchy infiltrates and hyperinflation), as diagnosed by consensus between a neonatologist and pediatric pulmonologist. The cohort had a mean gestational age of 39.7±1.4 weeks and mean birth weight of 3246±522g. Most babies were born outside Tygerberg hospital. High frequency oscillation was the most common initial mode of ventilation (55%). The median duration of invasive ventilation was 3 (IQR 2-4.5) days and total duration of respiratory support was a median of 9 (IQR 4-16) days. Surfactant was administered in 70% of neonates. Fifty-three percent of neonates developed pulmonary hypertension (PPHN) of which 88% received inhaled nitric oxide. Inotropes were required by 45% of neonates and steroids were administered in 64%. The incidence of pneumothorax on initial CXR was 9%. Neonates were discharged from NICU at a median age of 5 (IQR 3-7) days and had a hospital stay of 12 ( IQR 6-21) days. Overall mortality was 8.5%. Conclusion: This is the first study showing outcomes and mortality of MAS at Tygerberg Hospital. Mortality was low and is lower than resource restricted countries but remains higher than high resource countries. Similarly, complications associated with severe MAS, such as PPHN and pneumothorax, were also lower than in other resource restricted countries but higher than in high resource countries. Definitions for PPHN, choice of inotropes and steroids were variable and may have influenced various outcomes. This needs further investigation in future prospective studies.