RARE DISEASE
Meconium aspiration syndrome
Meconium aspiration syndrome
Meconium aspiration syndrome
Drug discovery
3
drugs
With orphan designations
Overview
Meconium Aspiration Syndrome (MAS) is a respiratory disorder in neonates caused by inhalation of meconium-stained amniotic fluid, leading to airway obstruction, surfactant inactivation, and chemical pneumonitis. It primarily affects term/post-term infants, often triggered by fetal distress. Complications include hypoxemia, pulmonary hypertension (PPHN), and pneumonia. Diagnosis relies on clinical signs (e.g., tachypnea, cyanosis) and chest X-ray findings [1][3][5][6].
Categories: rare respiratory diseases
Research Papers
847 drug discovery papers about Meconium aspiration syndrome, with 2 first-in-class and 6 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
847 drug discovery papers about Meconium aspiration syndrome, with 2 first-in-class and 6 next-in-class emerging drug candidates forecasted to outperform the average preclinical success rate. Recent publications:
categories:
Small molecules
small molecules
2026-07-21 | Use of Nebulized Corticosteroids Beyond Asthma and Chronic Obstructive Pulmonary Disease (COPD): A Scoping Review of Off-Label Respiratory and Perioperative Applications
Current literature suggests the potential benefits of nebulized corticosteroids (NCs), particularly budesonide and fluticasone, in the treatment of various respiratory conditions beyond their conventional application. This review aimed to comprehensively summarize the available evidence regarding the use of NCs for medical conditions beyond their conventional role in asthma and chronic obstructive pulmonary disease (COPD) management. This scoping review included all studies evaluating the use of NCs in children and adults for indications other than asthma and COPD. The search was limited to human studies published in English. Data were collected from the PubMed and Cochrane databases through December 2025. A narrative approach was employed to synthesize the extracted data, which are summarized and presented in tables and graphs. As this was a scoping review, formal risk of bias assessment and certainty of evidence evaluation were not performed. A predefined methodological approach was followed; however, no formal protocol registration was undertaken. A total of 302 articles were identified from various databases, of which 36 met the inclusion criteria. The included studies enrolled a total of 3,415 patients (range: 20-525) and primarily comprised randomized controlled trials, including double-blind placebo-controlled studies, prospective randomized studies, multicenter trials, pilot studies, and comparative interventional studies. Several indications beyond the conventional use of NCs in asthma/COPD were identified, including bronchiolitis, transient tachypnea of the newborn, respiratory complications after endotracheal intubation, croup, meconium aspiration syndrome, chronic rhinosinusitis, and viral wheezing. Overall, the available literature suggests that NCs may have therapeutic applications beyond asthma and COPD; however, the available evidence was heterogeneous with respect to indications, patient populations, study designs, and outcome measures. Further research is needed to clarify the effectiveness and safety of NCs, enabling evidence-based decision-making and improving patient-related outcomes.
2026-05-24 | [Use of inhaled nitric oxide during neonatal transport - a review of seven years of experience].
The management of newborns with persistent pulmonary hypertension has critical importance. These infants require immediate on-site intensive care, which must be continued during transport until arrival at a tertiary regional center. Inhaled nitric oxide is an effective pulmonary vasodilator, and its use during transport may support the treatment of pulmonary hypertension and ensure adequate gas exchange until handover in the intensive care unit. Since March 2018, the Neonatal Transport Service of the Peter Cerny Foundation has been the only provider in Hungary to administer inhaled nitric oxide during neonatal transport. To evaluate the use of inhaled nitric oxide during definitive on-site management and neonatal transport. In this retrospective cohort study, we analyzed data from newborn infants born between March 2018 and March 2025 who were transported by the Neonatal Transport Service of the Peter Cerny Foundation and received inhaled nitric oxide therapy. 5 patients were excluded due to postnatal age over one week or postmenstrual age exceeding 46 weeks, and 3 additional patients were excluded because of incomplete ventilation data. A total of 41 cases were included in the analysis. The mean gestational age was 38 weeks (range: 28-41). The most common primary diagnosis was meconium aspiration syndrome (n = 19), followed by congenital diaphragmatic hernia (n = 7). Prior to transport, 21 infants (51%) received surfactant therapy. 8 transports originated from outside the service's primary catchment area. In 9 cases, inhaled nitric oxide therapy was initiated by the local care team; in the remaining cases, treatment was started by the neonatal transport team, in more than one-third of patients before 6 hours of life. In 24 cases (58%), infants were transported using high-frequency oscillatory ventilation. 14 newborns (43.7%) showed a response to inhaled nitric oxide, defined as at least a 20% reduction in oxygen requirement by the end of transport. Extracorporeal membrane oxygenation therapy was initiated after transport in 3 cases. The administration of inhaled nitric oxide during neonatal transport is feasible and safe, and provides effective support for the initiation and maintenance of definitive intensive care in critically ill newborns until transfer to a regional tertiary center. Orv Hetil. 2026; 167(21): 824-832.
2026-03-24 | Efficacy of heparin in respiratory support of near-term rabbits with meconium-induced acute lung injury: Linear regression model analyses.
To explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications. Newborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models. Significantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible. The comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.
2026-02-02 | Meconium Aspiration Syndrome Complicated by Persistent Pulmonary Hypertension of the Newborn: A Case Report
Background: Meconium aspiration syndrome (MAS) is a significant cause of neonatal respiratory distress and is associated with considerable morbidity and mortality, particularly when complicated by persistent pulmonary hypertension of the newborn (PPHN). Early recognition and timely intervention are crucial for improving outcomes. Case Presentation: We report the case of a term male neonate born at 37 weeks of gestation with a birth weight of 2.9 kg, delivered by lower segment cesarean section in the presence of thick meconium-stained amniotic fluid. Although the infant cried immediately after birth, he developed respiratory distress and apnea episodes within the early postnatal period and was referred to a tertiary care center. On admission, the neonate was tachypneic with poor oxygen saturation. Laboratory investigations revealed an elevated C-reactive protein level, while other hematological parameters were within normal limits. Chest radiography demonstrated bilateral patchy pulmonary opacities with areas of hyperinflation, consistent with MAS. The clinical and radiological findings supported the diagnosis of MAS complicated by PPHN. Management and Outcome: The neonate was treated with oxygen support, mechanical ventilation, antibiotics, and general supportive care. Echocardiography confirmed PPHN, and appropriate heart and lung treatment was started. The baby gradually improved, was weaned off ventilatory support, and discharged in stable condition. Conclusion: This case highlights the importance of early imaging and comprehensive cardiopulmonary evaluation in diagnosing MAS complicated by PPHN. Prompt diagnosis and aggressive respiratory and supportive management can significantly improve clinical outcomes and reduce neonatal morbidity and mortality.
2026-01-25 | Incidence and Complications of Meconium Aspiration Syndrome in Term Neonates – A Prospective Observational Study
Background: Meconium aspiration syndrome (MAS) is a major respiratory condition in term neonates, occurring when meconium-stained amniotic fluid (MSAF) is aspirated, causing airway obstruction, inflammation, and surfactant dysfunction. MSAF is seen in 10-20% of term deliveries worldwide, with MAS developing in 5-30% of those cases depending on setting and meconium thickness. In India, higher rates are often reported in tertiary centers due to referral patterns and delayed care. Risk factors include post-term gestation, fetal distress, and thick meconium. Complications range from respiratory failure and pneumothorax to persistent pulmonary hypertension of the newborn (PPHN), hypoxic-ischemic encephalopathy, and mortality. Despite improvements in perinatal care, MAS contributes significantly to neonatal intensive care admissions. This study examined the incidence and complications of MAS in term neonates at a tertiary hospital in Gujarat, India, to provide local insights and support improved protocols. Material and Methods: This prospective observational study was carried out over a year at a tertiary care hospital in western Gujarat, screening 940 term deliveries. Neonates with MSAF were followed for MAS signs. Institutional Ethics Committee approval was obtained, following Helsinki guidelines, with parental informed consent. Inclusion: term (37-42 weeks) neonates with MSAF. Exclusion: preterm/post-term extremes, congenital anomalies, non-MSAF births, or incomplete data. Data included demographics, clinical features, complications, and outcomes via records and follow-up. SPSS version 25 was used; chi-square for associations, logistic regression for risks, p<0.05 significant. Results: Of 940 term deliveries, 132 (14%) had MSAF, and 16 (12.1%) developed MAS, giving an incidence of 1.7 per 100 live births. Males were 62.5% (10/16). Complications included respiratory failure (68.8%), pneumothorax (18.8%), PPHN (12.5%), neurological injury (12.5%), and sepsis (6.3%). Mortality was 6.25% (1 case). Detailed tables cover demographics, incidence by gestation, complications, and outcomes. Conclusion: MAS incidence in this cohort matches regional Indian trends, with notable preventable complications. Strengthening antenatal surveillance and timely delivery interventions could lower burden. Enhanced neonatal management in high-risk cases remains key.
proteins
2026-06-30 | Correlation of Elevated Cord Blood Nucleated RBC Count (nRBC) with Common Antenatal Risk Factors and Outcome in Term and Preterm Neonates
Introduction: Nucleated red blood cells (nRBCs) in umbilical cord blood are recognized as markers of fetal hypoxia, inflammation, and intrauterine stress. Elevated cord blood nRBC counts have been associated with adverse perinatal outcomes, including low APGAR scores, neonatal intensive care unit (NICU) admission, respiratory distress, sepsis, and mortality. Aim: This study aimed to evaluate the association of cord blood nRBC counts with antenatal risk factors and neonatal outcomes. Materials and Methods: A prospective observational study was conducted from July 2025 to January 2026. A total of 130 mother -neonate’s pairs were included. Cord blood samples were collected immediately after delivery and analyzed for complete blood count and nRBC estimation using an automated hematology analyzer and peripheral smear examination. Maternal, intrapartum, and neonatal variables were recorded. Statistical analysis was performed using SPSS version 45, with p<0.05 considered significant. Results: Among 130 neonates, 55 (42.3%) had elevated nRBC counts (>10/100 WBC). Elevated nRBC counts were significantly associated with pregnancy-induced hypertension (p=0.0074), maternal anemia (p=0.0134), antepartum hemorrhage (p=0.0122), thick meconium-stained liquor (p=0.0074), and multiple antenatal risk factors (p=0.0203). Neonates with elevated nRBC counts had higher rates of respiratory distress syndrome, hypoxic-ischemic encephalopathy, meconium aspiration syndrome, abnormal APGAR scores, NICU admission, prolonged NICU stay (Spearman’s rho=0.83), and mortality. Out of 10 neonatal deaths, 9(90%) had elevated nRBC counts (p=0.0019). Conclusion: Umbilical cord blood nRBC count is a simple, inexpensive, and reliable marker of antenatal fetal stress. Elevated nRBC levels are strongly associated with neonatal morbidity, prolonged NICU stay, and mortality, making them a valuable adjunct for early risk stratification and prediction of neonatal outcomes.
2026-04-24 | Meconium Aspiration Syndrome and the Association With Preschool Asthma.
Meconium aspiration syndrome (MAS) is an acute neonatal respiratory disorder resulting from aspiration of meconium-stained amniotic fluid, leading to airway obstruction, inflammation, and hypoxemia. Although its perinatal presentation is well described, its long-term association with asthma remains unknown. Is MAS associated with subsequent development of preschool asthma? A retrospective cohort study was conducted using a national database, which included infants born between 2010 and 2024 with continuous follow-up until 6 years of age. Each child with MAS was matched 1:4 with control participants without MAS using Mahalanobis distance matching. The primary outcome was asthma, defined by the Asthma Integrated Diagnosis Index, a specific composite measure. Secondary outcomes included individual asthma-related diagnoses and medication use. Kaplan-Meier analysis was performed to evaluate time to outcome, accounting for the age at which events occurred. Among 326,940 eligible children, 730 children (0.2%) had a diagnosis of MAS. After matching, MAS was associated with 64% higher proportion of asthma up to 6 years of age (95% CI, 1.29-2.06; P < .001). Other long-term respiratory morbidities, such as bronchiolitis and OSA, also were more frequent among survivors of MAS. Atopic conditions, including dermatitis, rhinitis, and food allergies, did not differ significantly between groups. Sensitivity analysis using inverse probability of treatment weighting supported these findings. Our results show that MAS is associated with increased risks of asthma and bronchiolitis in early childhood. These findings suggest that neonatal lung injury resulting from MAS may impair airway development, contributing to asthma inception.
2026-04-22 | An Audit of Morbidity and Mortality among Hospitalised Neonates in the Neonatal Intensive Care Unit of a Tertiary Care Teaching Hospital.
To identify trends in neonatal mortality and morbidity among neonates admitted to neonatal intensive care unit (NICU). A descriptive study. Department of Paediatric Medicine, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from January 2022 to July 2023. Data were collected using a pre-designed and standardised pro forma to ensure consistency and accuracy. The study cohort was followed from the time of admission until discharge, leaving against medical advice (LAMA), or death. SPSS software (version 27.0) was utilised for statistical analysis to determine the frequency and percentage of different morbidity and mortality parameters. A p-value of 0.05 was considered significant. In 19 months, a total of 1,324 newborns (males, 56.95%) were admitted, and 31.26% (n = 414) died. Prematurity (29.53%, n = 391) was the most frequent reason for admission, followed by septicaemia (20.61%, n = 273), neonatal jaundice (9.89%, n = 131), birth asphyxia (8.9%, n = 118), and meconium aspiration syndrome (MAS; 5.9%, n = 79). Case mortality rate was more in prematurity (51.91%, n = 203/391), followed by birth asphyxia (45.76%, n = 54/118), congenital anomalies (37.03%, n = 10/27), septicaemia (27.10%, n = 74/273), pneumonia (25%, n = 11/44), respiratory distress syndrome (RDS; 24.63%, n = 17/69), MAS (22.78%, n = 18/79), meningitis (15.30%, n = 15/98), and transient tachypnoea of neonates (TTN; 5.26%, n = 4/76). Prematurity, low birth weight, and septicaemia were the leading causes of neonatal mortality, showing a strong inverse correlation with survival. Timely care and management of term neonates and conditions such as jaundice significantly improved outcomes. Admission, Neonates, Morbidity, Mortality, NICU, Fatality.
2025-10-06 | What is the use of surfactant in a term baby with meconium aspiration syndrome?
Surfactant therapy, especially through lavage, may reduce respiratory complications in neonates with meconium aspiration syndrome, although effects on survival and ECMO requirements remain uncertain.
2025-08-14 | Effectiveness of A Respiratory Care Protocol Including Less Invasive Surfactant Administration in ≥ 35 Weeks Gestational Age Infants.
In October 2018, a respiratory care protocol (RCP) including less invasive surfactant administration (LISA), was introduced for preterm infants admitted on continuous positive airway pressure (CPAP). We compared respiratory care practices and outcomes of ≥ 35-week gestational age (GA) infants between a pre-RCP (Jan 2016 to September 2018) and a post-RCP cohort (Oct 2018 to Dec 2021). Infants requiring < 24 h of CPAP and diagnosed with meconium aspiration syndrome were excluded. Of the 260 infants meeting inclusion criteria, 126 belonged to the pre-RCP and 134 to post-RCP cohort. Compared to pre-RCP, a lower proportion of infants in the post-RCP received CPAP on admission but a higher proportion received surfactant therapy (8% vs 22%, p < 0.001). Notably, surfactant therapy was associated with lower FiO2 requirement for 24 h and respiratory severity score for 48 h in the post-RCP cohort. However, there was no difference in any of the outcomes such as the need for mechanical ventilation, incidence of pneumothorax and length of hospital stay between two cohorts. Implementing an RCP increased surfactant use with associated improvement in oxygenation but did not improve outcomes. Further studies are necessary to evaluate the role of LISA in ≥ 35-week GA infants.
antibodies
2026-03-28 | Predictors of adverse neonatal outcomes in low-risk nulliparous women at term with meconium-stained amniotic fluid.
Meconium-stained amniotic fluid (MSAF) has been linked to adverse neonatal outcomes, but most evidence comes from heterogeneous cohorts that included multiparous and high-risk women. Nulliparous women without comorbidities are generally considered low risk, yet their outcomes in the presence of MSAF remain less well defined. This study aimed to identify predictors of adverse neonatal outcomes in low-risk nulliparous women at term with MSAF. A retrospective cohort study. Seven hundred sixty low-risk nulliparous women with documented MSAF at term delivery between March 2020 and July 2024. A tertiary, university-affiliated medical center. Obstetric and neonatal data were extracted from electronic medical records. Maternal, intrapartum, and neonatal characteristics were compared between women with and without an adverse neonatal outcome. The latter was defined as the presence of at least one of the following: a 5-min Apgar score < 7, umbilical artery pH < 7.15, admission to the neonatal intensive care unit, the need for invasive ventilation, meconium aspiration syndrome, or neonatal death. Multivariable logistic regression was performed to identify independent predictors of adverse outcome. Among women with adverse neonatal outcomes (59, 7.8%) compared to those without adverse outcomes, the mean delivery was earlier (39.3 ± 2.5 vs 40.0 ± 1.0 weeks, p < 0.001) and the mean birthweight lower (3171.8 ± 698.8 g vs 3328.7 ± 413.2 g, p = 0.009). Prolonged rupture of membranes > 18 h was more common (11.9% vs 3.0%, p = 0.004), as was chorioamnionitis (22.0% vs 10.6%, p = 0.012). Meconium thickness was greater (p = 0.049). In multivariable logistic regression, early term delivery (adjusted odds ratio (aOR) 3.63, 95% CI 1.76-7.51), prolonged rupture of membranes > 18 h (aOR 4.27, 95% CI 1.93-9.47), moderate meconium (aOR 2.46, 95% CI 1.29-4.69), thick meconium (aOR 4.67, 95% CI 2.00-10.91), and chorioamnionitis (aOR 2.74, 95% CI 1.52-4.93) were independent predictors of an adverse neonatal outcome. The retrospective single-center design and limited number of adverse neonatal events may restrict generalizability and preclude assessing risks for specific morbidities. Among low-risk nulliparous women with MSAF, early term delivery, prolonged rupture of membranes, greater meconium thickness, and chorioamnionitis were associated with adverse neonatal outcomes. These factors may assist in predicting risk and guiding intrapartum management, though validation in larger prospective studies is needed.
2026-03-26 | Clinical Interventions and Outcomes in Neonates With Early-Onset Respiratory Distress: A Prospective Observational Study.
Neonatal respiratory distress (NRD) remains a major cause of early morbidity and mortality worldwide, accounting for a significant proportion of neonatal intensive care unit (NICU) admissions in developing countries. Understanding the etiological spectrum, clinical interventions, and short-term outcomes is crucial to guide evidence-based neonatal care in resource-limited settings. To evaluate the clinical characteristics, treatment modalities, and immediate outcomes among neonates presenting with early-onset respiratory distress within 72 hours of birth and to assess the influence of antenatal corticosteroid (ACS) exposure on disease severity. This prospective observational study included 1000 neonates admitted to the sick newborn care unit (SNCU) at Tirunelveli Medical College and Hospital, Tamil Nadu, India, over one year. Data on maternal, perinatal, and neonatal variables were collected using a structured proforma. Severity was assessed using the Silverman-Anderson and Downe's scores. Statistical analysis included chi-square and ANOVA tests, with p < 0.05 was considered significant. Among 1000 neonates, 56% were male and 56% were term. The major etiologies were transient tachypnea of the newborn (56%), respiratory distress syndrome (39%), and meconium aspiration syndrome (5%). Continuous positive airway pressure (CPAP) was required in 36% of cases, while 58% were managed with oxygen hood therapy. Severe distress occurred predominantly in preterm and low-birth-weight infants. Overall mortality was 1.9%, confined to the extremely preterm group. ACS exposure showed a trend toward lower severity and reduced need for invasive support. Early recognition and structured management, including timely CPAP initiation and antenatal corticosteroid use, significantly improve short-term outcomes in neonatal respiratory distress. Strengthening antenatal and neonatal care integration is essential for further mortality reduction in similar healthcare settings.
2026-01-29 | Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital - A retrospective cohort study.
The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one-third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a "trial of vaginal delivery" due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC-2). We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC-2 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records. Among 898 women with two previous CSs, 7.0% (63/898) attempted TOLAC-2, of whom 55.6% (35/63) achieved a successful vaginal birth (VBAC-2). Successful TOLAC-2 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7 h, p = 0.013) and lower estimated blood loss (242mLs vs. 423mLs, p ≤ 0.001) compared with failed TOLAC-2. There were no perinatal complications of uterine rupture, APGAR <7 at 5 minutes, meconium aspiration syndrome or hypoxic-ischemic encephalopathy. We observed a trend toward successful VBAC-2 in women with a history of prior vaginal birth (74.6% vs. 48.9% p = 0.07). In our cohort, more than half of the women attempting TOLAC-2 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC-2 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.
2024-10-28 | Study on Fetal and Maternal Outcome of Postdated Pregnancy
Postdated pregnancy is not so uncommon in obstetric practice. When a pregnancy crosses the expected date of delivery (beyond 280 days) it is called postdated pregnancy. The incidence is about 7% of all pregnancies. This prospective observational study was carried out in 165 postdated pregnancies admitted in the Department of Obstetrics & Gynaecology, during a period of 3 years from January 2021 to December 2023 . Majority of the patients were below 25 years of age (47.88%) and primigravida (41.82%). Most of the patients belonged to rural areas (55.75%) and were middle socio-economic status group (45.45%). The majority of these postdated women were delivered by NVD (52.12%), followed by LSCS (32.72%) and instrumental (15.15%). Postdated pregnancy was associated with perinatal complications like meconium aspiration syndrome, oligohydramnios, fetal birth injuries, septicemia, shoulder dystocia, non-reassuring fetal heart rate status, fetal distress in labour. There was an increased risk of maternal complications like increased caesarean section rate, post-partum hemorrhage (PPH) ,cervical tear, perineal tear. Management of postdated pregnancy is challenging. Careful advice and timely interventions can reduce fetomaternal complications. EWMCJ Vol. 12, No. 1&2, January-July 2024: 94-98
2023-09-12 | A Neonate With Cytokine Storm Managed With Steroids, Therapeutic Plasma Exchange, and Tocilizumab
Neonatal cytokine storms, though rare, can induce hyperinflammation due to elevated interleukin-6 (IL-6), triggering multiorgan failure. We present the case of a term male neonate necessitating extracorporeal membrane oxygenation (ECMO) post-birth for persistent pulmonary hypertension due to meconium aspiration syndrome. Three days after weaning from ECMO support, steroids and therapeutic plasma exchange were initiated due to deteriorating thrombocytopenia, oxygenation, hemodynamic instability, and increased C-reactive protein (CRP) and ferritin levels. Elevated IL-6 prompted tocilizumab administration after four days of daily plasmapheresis. Post-tocilizumab infusion, notable enhancements in platelet counts, oxygenation indices, and CRP were observed, resulting in stable discharge of the child. Comprehensive evaluations for infections, including coronavirus disease 2019, as well as genetic and metabolic disorders, yielded negative results.
cell therapies
2025-07-29 | Fetal outcomes of cord milking in term babies with meconium-stained amniotic fluid in a tertiary care centre: interventional type of study
Background: Umbilical cord milking (UCM) is proposed for increasing placental transfusion when immediate care for the newborn is needed enables blood to be directed into the baby more quickly than delayed cord clamping (DCC) at birth than waiting for this to happen physiologically. Any form of stress on the fetus and to mother can induce passage of meconium.6 Meconium-stained amniotic fluid results in increase the need of neonatal assistance, due to adverse outcomes such as respiratory distress, lower Apgar score, meconium aspiration syndrome and neonatal sepsis. From studies, it was observed that there was a gap in study of cord milking in term babies with MSAF. It was hypothesized that umbilical cord milking to be more beneficial that delayed as it can be performed more quickly, to babies with meconium-stained liquor requiring resuscitatory efforts. Therefore, a study was conducted to evaluate the maternal and fetal profile of term babies with meconium-stained liquor and their outcome on umbilical cord milking at the time of delivery. Methods: A interventional type of study was conducted with a sample size of 200 labouring patients admitted in labour ward with gestational age between 37 to 42 weeks with meconium-stained amniotic fluid in Tertiary Care Centre. Details regarding patient’s demographics, detailed history of period of gestation, high risk factors, past history, patient’s entire obstetric history was noted. During delivery, if cord milking and clamping done was noted. Fetal wellbeing through APGAR score of baby, resuscitation required, hematocrit at 48 hours, DSPT required and their septic screening results; was evaluated. Results: The present study was carried out on 200 labouring patients with meconium-stained amniotic fluid, admitted in labour ward in a tertiary health care centre. Baseline characteristics were comparable in both the groups. When we compared fetal profile in babies whose cord milking was done and in whom cord milking was not done, we observed that babies under UCM group, had better Apgar scores (at 1 min: 6.23 vs 5.77, p=0.0082) (at 5 min: 8.17 vs 7.36, p<0.0001), required less NICU admission, more hematocrit (53.58 vs 48.70, p<0.0001) and lower mortality (25% vs 75%) than non-milking group. Conclusions: Meconium-stained amniotic fluid is worrisome as it is associated with increased frequency of operative delivery, neonatal sepsis and neonatal intensive care unit admissions which requires appropriate intrapartum care. UCM can be a used as a placental transfusion strategy in neonates with meconium-stained amniotic fluid, requiring resuscitation with some benefits and minimum adverse effects. It could be considered as an alternative for the current practice of delayed cord clamping.
2017-08-25 | The effect of meconium exposure on the expression and differentiation of amniotic fluid mesenchymal stem cells
BACKGROUND:The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells.METHODS: Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low).AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression.Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined.As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium).RESULTS: After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium.These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days.Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours.Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated.High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM.After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups.CONCLUSION: The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression.This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype.However, these cells were still able to be differentiated to a distal lung phenotype.
small molecules
2026-07-21 | Use of Nebulized Corticosteroids Beyond Asthma and Chronic Obstructive Pulmonary Disease (COPD): A Scoping Review of Off-Label Respiratory and Perioperative Applications
Current literature suggests the potential benefits of nebulized corticosteroids (NCs), particularly budesonide and fluticasone, in the treatment of various respiratory conditions beyond their conventional application. This review aimed to comprehensively summarize the available evidence regarding the use of NCs for medical conditions beyond their conventional role in asthma and chronic obstructive pulmonary disease (COPD) management. This scoping review included all studies evaluating the use of NCs in children and adults for indications other than asthma and COPD. The search was limited to human studies published in English. Data were collected from the PubMed and Cochrane databases through December 2025. A narrative approach was employed to synthesize the extracted data, which are summarized and presented in tables and graphs. As this was a scoping review, formal risk of bias assessment and certainty of evidence evaluation were not performed. A predefined methodological approach was followed; however, no formal protocol registration was undertaken. A total of 302 articles were identified from various databases, of which 36 met the inclusion criteria. The included studies enrolled a total of 3,415 patients (range: 20-525) and primarily comprised randomized controlled trials, including double-blind placebo-controlled studies, prospective randomized studies, multicenter trials, pilot studies, and comparative interventional studies. Several indications beyond the conventional use of NCs in asthma/COPD were identified, including bronchiolitis, transient tachypnea of the newborn, respiratory complications after endotracheal intubation, croup, meconium aspiration syndrome, chronic rhinosinusitis, and viral wheezing. Overall, the available literature suggests that NCs may have therapeutic applications beyond asthma and COPD; however, the available evidence was heterogeneous with respect to indications, patient populations, study designs, and outcome measures. Further research is needed to clarify the effectiveness and safety of NCs, enabling evidence-based decision-making and improving patient-related outcomes.
2026-05-24 | [Use of inhaled nitric oxide during neonatal transport - a review of seven years of experience].
The management of newborns with persistent pulmonary hypertension has critical importance. These infants require immediate on-site intensive care, which must be continued during transport until arrival at a tertiary regional center. Inhaled nitric oxide is an effective pulmonary vasodilator, and its use during transport may support the treatment of pulmonary hypertension and ensure adequate gas exchange until handover in the intensive care unit. Since March 2018, the Neonatal Transport Service of the Peter Cerny Foundation has been the only provider in Hungary to administer inhaled nitric oxide during neonatal transport. To evaluate the use of inhaled nitric oxide during definitive on-site management and neonatal transport. In this retrospective cohort study, we analyzed data from newborn infants born between March 2018 and March 2025 who were transported by the Neonatal Transport Service of the Peter Cerny Foundation and received inhaled nitric oxide therapy. 5 patients were excluded due to postnatal age over one week or postmenstrual age exceeding 46 weeks, and 3 additional patients were excluded because of incomplete ventilation data. A total of 41 cases were included in the analysis. The mean gestational age was 38 weeks (range: 28-41). The most common primary diagnosis was meconium aspiration syndrome (n = 19), followed by congenital diaphragmatic hernia (n = 7). Prior to transport, 21 infants (51%) received surfactant therapy. 8 transports originated from outside the service's primary catchment area. In 9 cases, inhaled nitric oxide therapy was initiated by the local care team; in the remaining cases, treatment was started by the neonatal transport team, in more than one-third of patients before 6 hours of life. In 24 cases (58%), infants were transported using high-frequency oscillatory ventilation. 14 newborns (43.7%) showed a response to inhaled nitric oxide, defined as at least a 20% reduction in oxygen requirement by the end of transport. Extracorporeal membrane oxygenation therapy was initiated after transport in 3 cases. The administration of inhaled nitric oxide during neonatal transport is feasible and safe, and provides effective support for the initiation and maintenance of definitive intensive care in critically ill newborns until transfer to a regional tertiary center. Orv Hetil. 2026; 167(21): 824-832.
2026-03-24 | Efficacy of heparin in respiratory support of near-term rabbits with meconium-induced acute lung injury: Linear regression model analyses.
To explore the pharmacotherapeutic efficacy of heparin in the management of meconium-induced acute lung injury (ALI) in near-term newborn rabbits subjected to mechanical ventilation (MV) and ancillary respiratory medications. Newborn rabbits at 30-day gestation (term 31 days) were anesthetized, intratracheally intubated and received human meconium-saline suspension, followed by parallel MV with individually adjusted tidal volume in a multi-plethysmograph-ventilator system. When ALI was induced after initial 3-h MV, therapeutic effects of single or combined subcutaneous heparin (100 U/kg), surfactant (200 mg/kg), and inhaled nitric oxide (iNO, 10 ppm), were compared for lung protective ventilation and survival as outcome, analyzed with linear regression models. Significantly reduced respiratory compliance by meconium was reinstalled during ensuing 7-h MV, with improved survival, among the treatment groups. The impact was verified by lung injury severity, surfactant phospholipid pools, and multiple mRNA expressions of surfactant proteins, lung fluid clearance-related factors, inflammatory mediators, growth factors, endothelial cell injury and coagulation-related factors as subphenotyping biomarkers. The overall benefits of heparin alone, or exerted with the dual and triple regimens, were discernible by both generalized linear model and Cox proportional hazard ratio regression for survival and other major variables as outcome. Its adverse effects were intangible. The comparable efficacy of heparin, alongside the PS and NO, was corroborated in attenuating meconium-mediated, ventilator-induced ALI, which should warrant clinical investigation to validate.
2026-02-02 | Meconium Aspiration Syndrome Complicated by Persistent Pulmonary Hypertension of the Newborn: A Case Report
Background: Meconium aspiration syndrome (MAS) is a significant cause of neonatal respiratory distress and is associated with considerable morbidity and mortality, particularly when complicated by persistent pulmonary hypertension of the newborn (PPHN). Early recognition and timely intervention are crucial for improving outcomes. Case Presentation: We report the case of a term male neonate born at 37 weeks of gestation with a birth weight of 2.9 kg, delivered by lower segment cesarean section in the presence of thick meconium-stained amniotic fluid. Although the infant cried immediately after birth, he developed respiratory distress and apnea episodes within the early postnatal period and was referred to a tertiary care center. On admission, the neonate was tachypneic with poor oxygen saturation. Laboratory investigations revealed an elevated C-reactive protein level, while other hematological parameters were within normal limits. Chest radiography demonstrated bilateral patchy pulmonary opacities with areas of hyperinflation, consistent with MAS. The clinical and radiological findings supported the diagnosis of MAS complicated by PPHN. Management and Outcome: The neonate was treated with oxygen support, mechanical ventilation, antibiotics, and general supportive care. Echocardiography confirmed PPHN, and appropriate heart and lung treatment was started. The baby gradually improved, was weaned off ventilatory support, and discharged in stable condition. Conclusion: This case highlights the importance of early imaging and comprehensive cardiopulmonary evaluation in diagnosing MAS complicated by PPHN. Prompt diagnosis and aggressive respiratory and supportive management can significantly improve clinical outcomes and reduce neonatal morbidity and mortality.
2026-01-25 | Incidence and Complications of Meconium Aspiration Syndrome in Term Neonates – A Prospective Observational Study
Background: Meconium aspiration syndrome (MAS) is a major respiratory condition in term neonates, occurring when meconium-stained amniotic fluid (MSAF) is aspirated, causing airway obstruction, inflammation, and surfactant dysfunction. MSAF is seen in 10-20% of term deliveries worldwide, with MAS developing in 5-30% of those cases depending on setting and meconium thickness. In India, higher rates are often reported in tertiary centers due to referral patterns and delayed care. Risk factors include post-term gestation, fetal distress, and thick meconium. Complications range from respiratory failure and pneumothorax to persistent pulmonary hypertension of the newborn (PPHN), hypoxic-ischemic encephalopathy, and mortality. Despite improvements in perinatal care, MAS contributes significantly to neonatal intensive care admissions. This study examined the incidence and complications of MAS in term neonates at a tertiary hospital in Gujarat, India, to provide local insights and support improved protocols. Material and Methods: This prospective observational study was carried out over a year at a tertiary care hospital in western Gujarat, screening 940 term deliveries. Neonates with MSAF were followed for MAS signs. Institutional Ethics Committee approval was obtained, following Helsinki guidelines, with parental informed consent. Inclusion: term (37-42 weeks) neonates with MSAF. Exclusion: preterm/post-term extremes, congenital anomalies, non-MSAF births, or incomplete data. Data included demographics, clinical features, complications, and outcomes via records and follow-up. SPSS version 25 was used; chi-square for associations, logistic regression for risks, p<0.05 significant. Results: Of 940 term deliveries, 132 (14%) had MSAF, and 16 (12.1%) developed MAS, giving an incidence of 1.7 per 100 live births. Males were 62.5% (10/16). Complications included respiratory failure (68.8%), pneumothorax (18.8%), PPHN (12.5%), neurological injury (12.5%), and sepsis (6.3%). Mortality was 6.25% (1 case). Detailed tables cover demographics, incidence by gestation, complications, and outcomes. Conclusion: MAS incidence in this cohort matches regional Indian trends, with notable preventable complications. Strengthening antenatal surveillance and timely delivery interventions could lower burden. Enhanced neonatal management in high-risk cases remains key.
proteins
2026-06-30 | Correlation of Elevated Cord Blood Nucleated RBC Count (nRBC) with Common Antenatal Risk Factors and Outcome in Term and Preterm Neonates
Introduction: Nucleated red blood cells (nRBCs) in umbilical cord blood are recognized as markers of fetal hypoxia, inflammation, and intrauterine stress. Elevated cord blood nRBC counts have been associated with adverse perinatal outcomes, including low APGAR scores, neonatal intensive care unit (NICU) admission, respiratory distress, sepsis, and mortality. Aim: This study aimed to evaluate the association of cord blood nRBC counts with antenatal risk factors and neonatal outcomes. Materials and Methods: A prospective observational study was conducted from July 2025 to January 2026. A total of 130 mother -neonate’s pairs were included. Cord blood samples were collected immediately after delivery and analyzed for complete blood count and nRBC estimation using an automated hematology analyzer and peripheral smear examination. Maternal, intrapartum, and neonatal variables were recorded. Statistical analysis was performed using SPSS version 45, with p<0.05 considered significant. Results: Among 130 neonates, 55 (42.3%) had elevated nRBC counts (>10/100 WBC). Elevated nRBC counts were significantly associated with pregnancy-induced hypertension (p=0.0074), maternal anemia (p=0.0134), antepartum hemorrhage (p=0.0122), thick meconium-stained liquor (p=0.0074), and multiple antenatal risk factors (p=0.0203). Neonates with elevated nRBC counts had higher rates of respiratory distress syndrome, hypoxic-ischemic encephalopathy, meconium aspiration syndrome, abnormal APGAR scores, NICU admission, prolonged NICU stay (Spearman’s rho=0.83), and mortality. Out of 10 neonatal deaths, 9(90%) had elevated nRBC counts (p=0.0019). Conclusion: Umbilical cord blood nRBC count is a simple, inexpensive, and reliable marker of antenatal fetal stress. Elevated nRBC levels are strongly associated with neonatal morbidity, prolonged NICU stay, and mortality, making them a valuable adjunct for early risk stratification and prediction of neonatal outcomes.
2026-04-24 | Meconium Aspiration Syndrome and the Association With Preschool Asthma.
Meconium aspiration syndrome (MAS) is an acute neonatal respiratory disorder resulting from aspiration of meconium-stained amniotic fluid, leading to airway obstruction, inflammation, and hypoxemia. Although its perinatal presentation is well described, its long-term association with asthma remains unknown. Is MAS associated with subsequent development of preschool asthma? A retrospective cohort study was conducted using a national database, which included infants born between 2010 and 2024 with continuous follow-up until 6 years of age. Each child with MAS was matched 1:4 with control participants without MAS using Mahalanobis distance matching. The primary outcome was asthma, defined by the Asthma Integrated Diagnosis Index, a specific composite measure. Secondary outcomes included individual asthma-related diagnoses and medication use. Kaplan-Meier analysis was performed to evaluate time to outcome, accounting for the age at which events occurred. Among 326,940 eligible children, 730 children (0.2%) had a diagnosis of MAS. After matching, MAS was associated with 64% higher proportion of asthma up to 6 years of age (95% CI, 1.29-2.06; P < .001). Other long-term respiratory morbidities, such as bronchiolitis and OSA, also were more frequent among survivors of MAS. Atopic conditions, including dermatitis, rhinitis, and food allergies, did not differ significantly between groups. Sensitivity analysis using inverse probability of treatment weighting supported these findings. Our results show that MAS is associated with increased risks of asthma and bronchiolitis in early childhood. These findings suggest that neonatal lung injury resulting from MAS may impair airway development, contributing to asthma inception.
2026-04-22 | An Audit of Morbidity and Mortality among Hospitalised Neonates in the Neonatal Intensive Care Unit of a Tertiary Care Teaching Hospital.
To identify trends in neonatal mortality and morbidity among neonates admitted to neonatal intensive care unit (NICU). A descriptive study. Department of Paediatric Medicine, Services Institute of Medical Sciences and Services Hospital, Lahore, Pakistan, from January 2022 to July 2023. Data were collected using a pre-designed and standardised pro forma to ensure consistency and accuracy. The study cohort was followed from the time of admission until discharge, leaving against medical advice (LAMA), or death. SPSS software (version 27.0) was utilised for statistical analysis to determine the frequency and percentage of different morbidity and mortality parameters. A p-value of 0.05 was considered significant. In 19 months, a total of 1,324 newborns (males, 56.95%) were admitted, and 31.26% (n = 414) died. Prematurity (29.53%, n = 391) was the most frequent reason for admission, followed by septicaemia (20.61%, n = 273), neonatal jaundice (9.89%, n = 131), birth asphyxia (8.9%, n = 118), and meconium aspiration syndrome (MAS; 5.9%, n = 79). Case mortality rate was more in prematurity (51.91%, n = 203/391), followed by birth asphyxia (45.76%, n = 54/118), congenital anomalies (37.03%, n = 10/27), septicaemia (27.10%, n = 74/273), pneumonia (25%, n = 11/44), respiratory distress syndrome (RDS; 24.63%, n = 17/69), MAS (22.78%, n = 18/79), meningitis (15.30%, n = 15/98), and transient tachypnoea of neonates (TTN; 5.26%, n = 4/76). Prematurity, low birth weight, and septicaemia were the leading causes of neonatal mortality, showing a strong inverse correlation with survival. Timely care and management of term neonates and conditions such as jaundice significantly improved outcomes. Admission, Neonates, Morbidity, Mortality, NICU, Fatality.
2025-10-06 | What is the use of surfactant in a term baby with meconium aspiration syndrome?
Surfactant therapy, especially through lavage, may reduce respiratory complications in neonates with meconium aspiration syndrome, although effects on survival and ECMO requirements remain uncertain.
2025-08-14 | Effectiveness of A Respiratory Care Protocol Including Less Invasive Surfactant Administration in ≥ 35 Weeks Gestational Age Infants.
In October 2018, a respiratory care protocol (RCP) including less invasive surfactant administration (LISA), was introduced for preterm infants admitted on continuous positive airway pressure (CPAP). We compared respiratory care practices and outcomes of ≥ 35-week gestational age (GA) infants between a pre-RCP (Jan 2016 to September 2018) and a post-RCP cohort (Oct 2018 to Dec 2021). Infants requiring < 24 h of CPAP and diagnosed with meconium aspiration syndrome were excluded. Of the 260 infants meeting inclusion criteria, 126 belonged to the pre-RCP and 134 to post-RCP cohort. Compared to pre-RCP, a lower proportion of infants in the post-RCP received CPAP on admission but a higher proportion received surfactant therapy (8% vs 22%, p < 0.001). Notably, surfactant therapy was associated with lower FiO2 requirement for 24 h and respiratory severity score for 48 h in the post-RCP cohort. However, there was no difference in any of the outcomes such as the need for mechanical ventilation, incidence of pneumothorax and length of hospital stay between two cohorts. Implementing an RCP increased surfactant use with associated improvement in oxygenation but did not improve outcomes. Further studies are necessary to evaluate the role of LISA in ≥ 35-week GA infants.
antibodies
2026-03-28 | Predictors of adverse neonatal outcomes in low-risk nulliparous women at term with meconium-stained amniotic fluid.
Meconium-stained amniotic fluid (MSAF) has been linked to adverse neonatal outcomes, but most evidence comes from heterogeneous cohorts that included multiparous and high-risk women. Nulliparous women without comorbidities are generally considered low risk, yet their outcomes in the presence of MSAF remain less well defined. This study aimed to identify predictors of adverse neonatal outcomes in low-risk nulliparous women at term with MSAF. A retrospective cohort study. Seven hundred sixty low-risk nulliparous women with documented MSAF at term delivery between March 2020 and July 2024. A tertiary, university-affiliated medical center. Obstetric and neonatal data were extracted from electronic medical records. Maternal, intrapartum, and neonatal characteristics were compared between women with and without an adverse neonatal outcome. The latter was defined as the presence of at least one of the following: a 5-min Apgar score < 7, umbilical artery pH < 7.15, admission to the neonatal intensive care unit, the need for invasive ventilation, meconium aspiration syndrome, or neonatal death. Multivariable logistic regression was performed to identify independent predictors of adverse outcome. Among women with adverse neonatal outcomes (59, 7.8%) compared to those without adverse outcomes, the mean delivery was earlier (39.3 ± 2.5 vs 40.0 ± 1.0 weeks, p < 0.001) and the mean birthweight lower (3171.8 ± 698.8 g vs 3328.7 ± 413.2 g, p = 0.009). Prolonged rupture of membranes > 18 h was more common (11.9% vs 3.0%, p = 0.004), as was chorioamnionitis (22.0% vs 10.6%, p = 0.012). Meconium thickness was greater (p = 0.049). In multivariable logistic regression, early term delivery (adjusted odds ratio (aOR) 3.63, 95% CI 1.76-7.51), prolonged rupture of membranes > 18 h (aOR 4.27, 95% CI 1.93-9.47), moderate meconium (aOR 2.46, 95% CI 1.29-4.69), thick meconium (aOR 4.67, 95% CI 2.00-10.91), and chorioamnionitis (aOR 2.74, 95% CI 1.52-4.93) were independent predictors of an adverse neonatal outcome. The retrospective single-center design and limited number of adverse neonatal events may restrict generalizability and preclude assessing risks for specific morbidities. Among low-risk nulliparous women with MSAF, early term delivery, prolonged rupture of membranes, greater meconium thickness, and chorioamnionitis were associated with adverse neonatal outcomes. These factors may assist in predicting risk and guiding intrapartum management, though validation in larger prospective studies is needed.
2026-03-26 | Clinical Interventions and Outcomes in Neonates With Early-Onset Respiratory Distress: A Prospective Observational Study.
Neonatal respiratory distress (NRD) remains a major cause of early morbidity and mortality worldwide, accounting for a significant proportion of neonatal intensive care unit (NICU) admissions in developing countries. Understanding the etiological spectrum, clinical interventions, and short-term outcomes is crucial to guide evidence-based neonatal care in resource-limited settings. To evaluate the clinical characteristics, treatment modalities, and immediate outcomes among neonates presenting with early-onset respiratory distress within 72 hours of birth and to assess the influence of antenatal corticosteroid (ACS) exposure on disease severity. This prospective observational study included 1000 neonates admitted to the sick newborn care unit (SNCU) at Tirunelveli Medical College and Hospital, Tamil Nadu, India, over one year. Data on maternal, perinatal, and neonatal variables were collected using a structured proforma. Severity was assessed using the Silverman-Anderson and Downe's scores. Statistical analysis included chi-square and ANOVA tests, with p < 0.05 was considered significant. Among 1000 neonates, 56% were male and 56% were term. The major etiologies were transient tachypnea of the newborn (56%), respiratory distress syndrome (39%), and meconium aspiration syndrome (5%). Continuous positive airway pressure (CPAP) was required in 36% of cases, while 58% were managed with oxygen hood therapy. Severe distress occurred predominantly in preterm and low-birth-weight infants. Overall mortality was 1.9%, confined to the extremely preterm group. ACS exposure showed a trend toward lower severity and reduced need for invasive support. Early recognition and structured management, including timely CPAP initiation and antenatal corticosteroid use, significantly improve short-term outcomes in neonatal respiratory distress. Strengthening antenatal and neonatal care integration is essential for further mortality reduction in similar healthcare settings.
2026-01-29 | Nine years' experience of trial of labor after two previous cesarean sections at a tertiary hospital - A retrospective cohort study.
The global cesarean section (CS) rate has increased to 21.1% between 1990 and 2018. In Singapore, the annual CS rate has increased by ~ 0.6%, reaching an overall rate of 37.4%. Almost one-third of all cesarean deliveries are performed for at least one previous CS. Women with two CSs are often denied a "trial of vaginal delivery" due to the increased risk of uterine scar rupture. This study aims to examine maternal and neonatal outcomes of women undergoing trials of labor following two CSs (TOLAC-2). We conducted a retrospective observational study of women with singleton, term pregnancies in cephalic presentation who underwent TOLAC-2 at the National University Hospital, Singapore, between September 2013 and June 2022. Data were obtained through a detailed review of electronic medical records. Among 898 women with two previous CSs, 7.0% (63/898) attempted TOLAC-2, of whom 55.6% (35/63) achieved a successful vaginal birth (VBAC-2). Successful TOLAC-2 was associated with a significantly shorter duration of active labor (5.0 vs. 7.7 h, p = 0.013) and lower estimated blood loss (242mLs vs. 423mLs, p ≤ 0.001) compared with failed TOLAC-2. There were no perinatal complications of uterine rupture, APGAR <7 at 5 minutes, meconium aspiration syndrome or hypoxic-ischemic encephalopathy. We observed a trend toward successful VBAC-2 in women with a history of prior vaginal birth (74.6% vs. 48.9% p = 0.07). In our cohort, more than half of the women attempting TOLAC-2 at term achieved a successful vaginal birth without serious perinatal or maternal complications. TOLAC-2 is a safe and reasonable option for appropriately selected women following adequate counseling, even in the absence of a prior vaginal delivery.
2024-10-28 | Study on Fetal and Maternal Outcome of Postdated Pregnancy
Postdated pregnancy is not so uncommon in obstetric practice. When a pregnancy crosses the expected date of delivery (beyond 280 days) it is called postdated pregnancy. The incidence is about 7% of all pregnancies. This prospective observational study was carried out in 165 postdated pregnancies admitted in the Department of Obstetrics & Gynaecology, during a period of 3 years from January 2021 to December 2023 . Majority of the patients were below 25 years of age (47.88%) and primigravida (41.82%). Most of the patients belonged to rural areas (55.75%) and were middle socio-economic status group (45.45%). The majority of these postdated women were delivered by NVD (52.12%), followed by LSCS (32.72%) and instrumental (15.15%). Postdated pregnancy was associated with perinatal complications like meconium aspiration syndrome, oligohydramnios, fetal birth injuries, septicemia, shoulder dystocia, non-reassuring fetal heart rate status, fetal distress in labour. There was an increased risk of maternal complications like increased caesarean section rate, post-partum hemorrhage (PPH) ,cervical tear, perineal tear. Management of postdated pregnancy is challenging. Careful advice and timely interventions can reduce fetomaternal complications. EWMCJ Vol. 12, No. 1&2, January-July 2024: 94-98
2023-09-12 | A Neonate With Cytokine Storm Managed With Steroids, Therapeutic Plasma Exchange, and Tocilizumab
Neonatal cytokine storms, though rare, can induce hyperinflammation due to elevated interleukin-6 (IL-6), triggering multiorgan failure. We present the case of a term male neonate necessitating extracorporeal membrane oxygenation (ECMO) post-birth for persistent pulmonary hypertension due to meconium aspiration syndrome. Three days after weaning from ECMO support, steroids and therapeutic plasma exchange were initiated due to deteriorating thrombocytopenia, oxygenation, hemodynamic instability, and increased C-reactive protein (CRP) and ferritin levels. Elevated IL-6 prompted tocilizumab administration after four days of daily plasmapheresis. Post-tocilizumab infusion, notable enhancements in platelet counts, oxygenation indices, and CRP were observed, resulting in stable discharge of the child. Comprehensive evaluations for infections, including coronavirus disease 2019, as well as genetic and metabolic disorders, yielded negative results.
cell therapies
2025-07-29 | Fetal outcomes of cord milking in term babies with meconium-stained amniotic fluid in a tertiary care centre: interventional type of study
Background: Umbilical cord milking (UCM) is proposed for increasing placental transfusion when immediate care for the newborn is needed enables blood to be directed into the baby more quickly than delayed cord clamping (DCC) at birth than waiting for this to happen physiologically. Any form of stress on the fetus and to mother can induce passage of meconium.6 Meconium-stained amniotic fluid results in increase the need of neonatal assistance, due to adverse outcomes such as respiratory distress, lower Apgar score, meconium aspiration syndrome and neonatal sepsis. From studies, it was observed that there was a gap in study of cord milking in term babies with MSAF. It was hypothesized that umbilical cord milking to be more beneficial that delayed as it can be performed more quickly, to babies with meconium-stained liquor requiring resuscitatory efforts. Therefore, a study was conducted to evaluate the maternal and fetal profile of term babies with meconium-stained liquor and their outcome on umbilical cord milking at the time of delivery. Methods: A interventional type of study was conducted with a sample size of 200 labouring patients admitted in labour ward with gestational age between 37 to 42 weeks with meconium-stained amniotic fluid in Tertiary Care Centre. Details regarding patient’s demographics, detailed history of period of gestation, high risk factors, past history, patient’s entire obstetric history was noted. During delivery, if cord milking and clamping done was noted. Fetal wellbeing through APGAR score of baby, resuscitation required, hematocrit at 48 hours, DSPT required and their septic screening results; was evaluated. Results: The present study was carried out on 200 labouring patients with meconium-stained amniotic fluid, admitted in labour ward in a tertiary health care centre. Baseline characteristics were comparable in both the groups. When we compared fetal profile in babies whose cord milking was done and in whom cord milking was not done, we observed that babies under UCM group, had better Apgar scores (at 1 min: 6.23 vs 5.77, p=0.0082) (at 5 min: 8.17 vs 7.36, p<0.0001), required less NICU admission, more hematocrit (53.58 vs 48.70, p<0.0001) and lower mortality (25% vs 75%) than non-milking group. Conclusions: Meconium-stained amniotic fluid is worrisome as it is associated with increased frequency of operative delivery, neonatal sepsis and neonatal intensive care unit admissions which requires appropriate intrapartum care. UCM can be a used as a placental transfusion strategy in neonates with meconium-stained amniotic fluid, requiring resuscitation with some benefits and minimum adverse effects. It could be considered as an alternative for the current practice of delayed cord clamping.
2017-08-25 | The effect of meconium exposure on the expression and differentiation of amniotic fluid mesenchymal stem cells
BACKGROUND:The goal of this study was to determine if exposure to meconium would alter the phenotype of amniotic fluid mesenchymal stem cells (AF-MSCs) and the ability of these cells to be differentiated into distal airway type cells.METHODS: Meconium was collected, lyophilized and resuspended in PBS at 3 different concentrations (high, medium, and low).AF-MSCs were cultured in the presence of this meconium suspension for 8 hours and then analyzed for changes in gene expression.Additionally, AF-MSCs exposed to meconium were differentiated for 14 days using modified small airway growth medium (mSAGM) and gene expression was determined.As a spontaneous differentiation control, meconium exposed AF-MSCs were cultured in amniotic fluid stem cell medium (AF medium).RESULTS: After 8 hours of exposure in culture, AF-MSCs had increased expression of distal airway genes aquaporin 5 (AQP5) and surfactant protein c (SPC) when cultured in AF medium containing meconium.These gene expression levels were similar to that of AF-MSCs that were differentiated in mSAGM for 14 days.Furthermore, there was an up regulation of pluripotency genes NANOG and OCT4 in response to low meconium concentration for 8 hours.Following 14 days of culture in mSAGM, there was an upregulation of TTF1, SPC and AQP5 expression in the control, as well as in the low and medium meconium exposed groups indicating that these cells were still able to be differentiated.High meconium concentration did, however, appear to influence the level of distal airway gene expression after 14 days in mSAGM.After 14 days in AF medium, there was significant downregulation in pluripotency and mesenchymal markers as well as distal airway gene expression in all groups.CONCLUSION: The phenotype of AF-MSCs is modulated by meconium exposure; however, the cells were still able to differentiate into distal airway gene and protein expression.This result supports the hypothesis that progenitor cells exist in the amniotic fluid and the presence of meconium may affect their initial phenotype.However, these cells were still able to be differentiated to a distal lung phenotype.
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Drug Discovery Landscape
3 orphan drug designations for Meconium aspiration syndrome.
3 orphan drug designations for Meconium aspiration syndrome.
Drug | Therapy type | Regulator | Orphan designation | Approval | Sponsor |
|---|---|---|---|---|---|
Colfosceril palmitate, Palmitic acid, Sinapultide, Sodium 1-palmitoyl-2-oleoyl-sn-glycero-3-(phospho-rac-(1-glycerol)) [Surfaxin] | proteins | EMA | 2001-09-19 | — | [INACTIVE] Discovery Laboratories, Inc. |
Lucinactant | small molecules | FDA | 1996-07-30 | — | Windtree Therapeutics, Inc. |
Beractant | other | FDA | 1993-12-20 | — | Ross Laboratories |
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