[IrelandsMama]

I hear birth pro's say that mec aspiration is associated with postdates babies. Is this really true? I need to do some reading I guess, but I thought we are learning more and more that mec most likely is happening way before labor, so why are postdates babies more likely to aspirate?

Another comment from a nurse that has me thinking is a baby less likely to aspirate the mec if born by c-section rather than vaginally? Why is this or isn't this true?

And when we look at the numbers of babies diagnosed with mec aspiration in hospitals do you think it's a honest number? Because I'm starting to think that any baby that has mec in their mouths get the diagnosis.

Sav

 

[MsBlack]

It may be that postdates babies more often pass mec in utero, but I have not seen (in life or research) that later babies more often inhale mec. I'd be interested to see any data on this.

As far as it being more likely for a baby to inhale mec during vag birth than csec--well that is surely a crock of bull, spoken by someone who really doesn't know. Someone who believes that natural, vaginal birth is necessarily stressful or traumatic to babies--in a way that makes them more likely to try to breathe in utero--and that csec is easier on them.

And no, I do not believe that hospital mec aspiration reporting is entirely accurate. I think you are right, that any baby with mec in his/her mouth/nose, and especially those who have any early signs of RDS, are assumed to have aspirated mec and are treated accordingly. I think what is 'honestly reported' is the number of babes *treated * for MAS--but that that number is far higher than the number of babes who actually did aspirate mec.

 

[NaturalMindedMomma]

Quote:

Originally Posted by MsBlack It may be that postdates babies more often pass mec in utero, but I have not seen (in life or research) that later babies more often inhale mec. I'd be interested to see any data on this. As far as it being more likely for a baby to inhale mec during vag birth than csec--well that is surely a crock of bull, spoken by someone who really doesn't know. Someone who believes that natural, vaginal birth is necessarily stressful or traumatic to babies--in a way that makes them more likely to try to breathe in utero--and that csec is easier on them. And no, I do not believe that hospital mec aspiration reporting is entirely accurate. I think you are right, that any baby with mec in his/her mouth/nose, and especially those who have any early signs of RDS, are assumed to have aspirated mec and are treated accordingly. I think what is 'honestly reported' is the number of babes *treated * for MAS--but that that number is far higher than the number of babes who actually did aspirate mec.

This wouldn't surprise me. There are a lot of "just because" treatments in hospitals.

 

[JamieCatheryn]

As for vaginal vs surgical birth's effect, wouldn't the whole fetal Heimlich thing on the way out tend to clear that more often? Maybe there is meconium present more often with vaginal, but aspiration I don't figure would be as much risk. I think these arguments assume if there is any mec the baby will aspirate it. I didn't get to see it from my angle at my son's birth (of course) but it seems the chest getting squeezed once the head's out makes them spew a lot of fluid out of the nose and mouth.

 

[mwherbs]

from a recently published a 10 year retrospective review of cases of MAS/suspected MAS-- in the Journal of Perinatology jan 2009-- so the retrospective was fairly large-
here is what they it says in a nut shell--
total of 415 772 neonates formed the starting data set and 162 075 (39%) were >/=37 weeks. Of the 162 075 term neonates, 7518(1.8% of all neonates and 4.6% of term NICU admissions) had an admission
diagnosis of MAS. In the 7518 neonates, the following outcomes were observed: 6124 (81.5%) were discharged home; 679 (9%) were acutely transferred to a higher level of intensive care; 416 (5.5%) were transferred to another clinical service within the hospital; 178 (2.4%) were transferred to another NICU for convalescent care and 88 (1.2%) died. There were 33 (0.4%) who did not have data on outcome at discharge.

this seems to be supporting the view that MAS is over dx- or atleast it was very very mild 81/5% of the time in the term infants they had cared for.
the studies seem to be all over the place as far as MAS and post-dates goes-- I have read some studies that support the idea that term infants don't have it as much and others that say is a problem--

 

[MsBlack]

Not being much of a statistician, just want to clarify something if possible:

88 babies died, presumably from MAS. This is 88 out of the starting number of term neonates, right--babies at least 37 wks gestation, all babies in the study who were 37 wks or any number of weeks beyond that?

And, I can't remember this morning how to figure the % of all term neonates who died. You quoted 1.2%, but that is the % of babies dxed w/MAS that died, correct? So, looking for the % of all term neonates who died of MAS--that would be 88 of 162, 075...right?

Any of you who know stats better than me, please do the math--or remind me how. I know I've learned this somewhere along the way, can't seem to find the mental file tho. Can you tell I don't mess with stats much

 

[mwherbs]

so this is admissions to NICU the total number in that 10 years time was
415,772 neonates, out of that number 162,075 (39%) were >/=37 (or another way to phrase that they were greater than or equal to 37 weeks) out of that number 7518(1.8% of all neonates and 4.6% of term NICU admissions) had an admission diagnosis of MAS-- the majority of these babies were sent home- 6174 (81%) the rest-33 they lost the data,1,311 of these >/= 37 weeks MAS babies were kept, transferrer or, convalesced , and 88 died --- that percent is calculated 88/7518 (1.17% they rounded up) so 1.17 percent of those term babies with an admitting diagnosis of MAS died the percent is much higher if we were to only look at those babies that were sick from MAS-88/1311 or 6.71% died

 

[MsBlack]

So, of those term babies dxed with MAS, 1.2% died. I get that.

What I was looking for was % of ALL fullterm babies who die of mec, but I see now that we don't have those numbers in front of us. What we have is 162,075 full term NICU admissions--so we *could* calculate the % of term NICU admissions who died of MAS (88/162 075--and that *was* the equation I was trying to use, I think my calculator must be broken!). I guess we'd have to know the birth rate for ALL full term infants (including the healthy ones, that is) during the study period, to get the % of all term infants who die of MAS.

I mean, I've understood for awhile that death via MAS is pretty rare. These numbers at least hint at just how rare, among the general population.

 

[mwherbs]

it also shows what you were talking about before that the dx of MAS is handed out unnecessarily or atleast freely- so 89% of presumed MAS are not ill and are released from the hospital --- I would like to see that their diagnosis process become more exact quicker-- because we all know that new moms and babies don't really need all the drama

 

[IrelandsMama]

Thanks for the thoughts and stats....

Sav