Prediction score for prolonged hospital stay in Meconium aspiration
syndrome: A Multicentric collaborative cohort of South India
Abstract
Background and Objective: With improved survival in neonates
with meconium aspiration syndrome (MAS), the focus is currently on
mitigating the morbidities. The objective of this study was to predict
factors determining prolonged hospital stay in neonates with MAS.
Materials and methods: It was a retrospective cohort from five
centres of south India between 2018 and 2020. Neonates ≥35 weeks of
gestation admitted to NICU with the diagnosis of MAS and requiring
oxygen beyond 24 hours of life were included in the study. The
morbidities in the neonates with stay ≤7 days (short stay) were compared
with >7 days (prolonged stay). Logistic regression by the
backward stepwise method was used for predictive score creation.
Results: Out of 347 neonates with MAS discharged home, 103
(29%) had a short stay and 244 (71%) had prolonged stay. The primary
support beyond O2 (CPAP/MV) (42% vs 83%, p<0.001), FiO2 at
1hr>30% (45% vs 87%, p<0.001), HIE stage 2 or
3 (2% vs 27%, p<0.001), moderate-severe PPHN (3% vs 31%,
p<0.001) were independent factors associated with prolonged
stay on logistic regression. A prediction model was devised using
weighted scores of these four associated morbidities. The clinical score
thus developed had 83% sensitivity, 68% specificity for the prediction
of prolonged stay [AUC- 82, 95% CI (78-87), p<0.001].
Conclusion: More than two-thirds of neonates with MAS had
prolonged stay. The primary support beyond oxygen, Fio2 requirement
>30%, Moderate to severe PPHN, HIE stage 2 or 3 were
predictive of prolonged stay in neonates with MAS.