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Transitional Hemodynamics in Neonates Born Through Meconium-Stained Amniotic Fluid: A Prospective Observational Study

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Abstract

Neonates born through meconium-stained amniotic fluid (MSAF) are at increased risk of altered cardiopulmonary transition at birth. There is a paucity of literature evaluating the transitional hemodynamics in these neonates. We aimed to evaluate transitional hemodynamics via echocardiography in neonates born through MSAF, compared to healthy neonates. The primary objective was to assess pulmonary vascular resistance using left pulmonary artery-velocity time integral (LPA-VTI). The secondary objectives were to assess other pulmonary vascular parameters and myocardial function. We enrolled 35 MSAF-born and 35 healthy neonates. Echocardiography was performed at 24 and 48 h of life by a pediatric cardiologist. Echocardiographic parameters were compared between MSAF-born and healthy neonates, and between MSAF-born neonates who developed meconium aspiration syndrome (MAS) and who did not (non-MAS). Among 35 MSAF-born neonates, 14 (40%) were non-vigorous, 18 (51%) required admission to neonatal intensive care unit, 8 (23%) developed MAS, 3 (9%) pulmonary hypertension and 1 (3%) air leak. On echocardiography, LPA-VTI (cm; mean ± SD) was significantly decreased at 24 and 48 h in MSAF-born neonates (14.38 ± 2.48; 15.55 ± 2.48), compared to healthy neonates (16.60 ± 2.14; 17.66 ± 2.71), respectively. Further, LPA-VTI was significantly reduced at 24 and 48 h among MAS (11.81 ± 3.0; 12.43 ± 2.5), compared to non-MAS neonates (15.15 ± 1.72; 16.48 ± 1.55), respectively. Other pulmonary vascular and myocardial function parameters were comparable between the two groups. Pulmonary adaptation was significantly delayed in neonates with MSAF, which was more pronounced in MAS neonates. Further studies should explore the utility of these parameters for early prediction of cardiorespiratory morbidities in this population.

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Data Availability

Individual de-identified participant data will be shared to researchers whose proposed use of the data has been approved by an independent review committee identified for this purpose. Proposals should be directed to Professor Sriparna Basu at E-mail ID sriparna.neonat@aiimsrishikesh.edu.in. Data will be available beginning 9 months and ending 36 months following article publication.

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Contributions

Dr Joshi recruited patients, collected, and analyzed the data, and drafted the initial manuscript; Drs Priyadarshi, Shrivastava, Chaurasia, Singh, and Basu supervised data collection and analysis of data and did critical revision and finalization of the manuscript; Dr Bhat contributed to the study design, data analysis, and interpretation; and all authors approved the final manuscript as submitted.

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Correspondence to Sriparna Basu.

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None of the authors have any conflicts of interest relevant to this article to disclose.

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Approved by the Institute Ethics Committee, All India Institute of Medical Sciences, Rishikesh, India (Ref No: AIIMS/IEC/21/503, dated 02/09/2021).

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Joshi, K., Priyadarshi, M., Shrivastava, Y. et al. Transitional Hemodynamics in Neonates Born Through Meconium-Stained Amniotic Fluid: A Prospective Observational Study. Pediatr Cardiol (2024). https://doi.org/10.1007/s00246-024-03521-w

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