The outcome of newborns born through grade 3 meconium-stained amniotic fluid in a regional hospital in Durban, KwaZulu-Natal

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S L Ngaka
P Tinarwo
R Singh


Background. Meconium-stained amniotic fluid (MSAF) may reflect normal fetal gut maturation or may indicate fetal compromise. Protocols on the management of newborns with grade 3 MSAF exposure who do not require immediate resuscitation at birth, are required. Objectives. To determine the outcomes of newborns born through grade 3 MSAF.

Methods. A retrospective chart review was conducted at King Edward VIII Hospital (KEH) in Durban, KwaZulu-Natal (KZN), South Africa (SA) from 1 January to 31 December 2018. Data were collected from 238 newborns born through grade 3 MSAF to determine the incidence of neonatal sepsis, respiratory complications and neurological complications associated with grade 3 MSAF exposure. Descriptive statistics were used.

Result. Neonatal sepsis was suspected in 10.5% of the grade 3 MSAF-exposed newborns and confirmed in 1.7% of the cases. Respiratory distress occurred in 18.9% of newborns, with 9.2% requiring supplementary oxygen. Neurological complications occurred in 2.9% of grade 3 MSAF- exposed newborns and 2.2% of newborns complicated with seizures

Conclusion. There was a low rate of neonatal sepsis, respiratory distress, neurological complications and perinatal asphyxia in newborns exposed to grade 3 MSAF. Neonates who are stable at birth can be observed in the postnatal ward for a short period after birth before discharge.

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How to Cite
The outcome of newborns born through grade 3 meconium-stained amniotic fluid in a regional hospital in Durban, KwaZulu-Natal. (2024). South African Journal of Child Health, 18(1), e2015.

How to Cite

The outcome of newborns born through grade 3 meconium-stained amniotic fluid in a regional hospital in Durban, KwaZulu-Natal. (2024). South African Journal of Child Health, 18(1), e2015.


Manivannan V, Jegan Murugan R, Devandiran RS. A study on clinical profile of meconium aspiration syndrome in relation to gestational age and birth weight and their immediate outcome. Int J Contemp Pediatr 2019;6(6):234- 235.

Swarnam K, Soraisham AS, Sivanandan S. Advances in the management of meconium aspiration syndrome. Int J Paediatrics 2011;2012(ID 359571):1-7.

Mundhra R, Agarwal M. Fetal outcomes in meconium-stained deliveries. J Clin Diagn Res 2013;7(12):2874-2876.

Usharani SM. Meconium stained liquor and its maternal and foetal outcome. J Evolution Med Dent Sci 2019;8(49):3653-3656.


Velaphi S, Vidyasagar D. Intrapartum and postdelivery management of infants born to mothers with meconium-stained amniotic fluid: Evidence-based recommendations. Clin Perinatol 2006;33(1):29-42. clp.2005.11.014

Kumari R, Srichand P, Devrajani BR, et al. Foetal outcome in patients with meconium stained liquor. J Pak Med Assoc 2012;62(5):474-476. https://www. (accessed 06 August 2018).

Malik AS, Hillman D. Meconium aspiration syndrome and neonatal outcome in developing country. Ann Trop Paediatr 1994;14(1):47-51. .1080/02724936.1994.11747691

Itzhaki-Bachar L, Meyer R, Levin G, Weismann-Brenner A. Incidental finding of meconium-stained amniotic fluid in elective caesarean deliveries: Features and perils. Int J Gynaecol Obstet 2021;158(2):418-423. ijgo.13997

Child Health Resource Package: Neonatal guidelines Department of Paediatrics Pietermaritzburg Metropolitan Hospitals Complex. https://www.kznhealth. (accessed 11 August 2018).

Velaphi S, Van Kwawegen A. Meconium aspiration syndrome requiring assisted ventilation: perspective in a setting with limited resources. J Perinatol 2008;28 (suppl 3):S36-S42.

Wyckoff M, Aziz K, Escobedo MB, Kapadia VS, et al. Part 13: Neonatal resuscitation, 2015 American Heart Association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(suppl 2):S543-S560.

Dhannaram V, Kotapuri S, Chitgupkar S. Study of early neonatal outcomes in babies delivered through meconium-stained amniotic fluid in rural teaching hospital. Int J Contemp Pediatr 2021;8(4):642-646. 3291.ijcp20211070

Ali MB, Maruf AA, Naher N, Islam S. Outcome in meconium stained amniotic fluid (MSAF): A study in a neonatal high dependency unit (NHDU) of a Medical College Hospital. Mediscope 2019;6(2):65-71. mediscope.v6i2.43155

Divon MY, Ferber A, Nisell H, Westgren M. Male gender predisposes to prolongation of pregnancy. Am J Obstet Gynaecol 2002;187(4):1081-1083.

Gupta SK, Haerr P, David R, Rastogi A, Pyati S. Meconium aspiration syndrome in infants of HIV-positive women: a case-control study. J Perinat Med 2016;44(4):469-475.

Saunders K. Should we worry about meconium? A controlled study of neonatal outcome. Trop Doct 2002;32(1):7-10. 17. Nesa F, Chowdhury F, Yasmeen BH, Rahman S. Mode of delivery and fetal outcome in meconium-stained amniotic fluid in DMCH. North Int Med Coll J


Patra S, Shruthi SS, Puri M, Nangia S, Trivedi SS. Meconium stained liquor in labour and mode of delivery: a time for reappraisal. International Journal of Reproduction, Contraception, Obstetrics and Gynecology 2020;9(10):4016- 4021.


Olicker AL, Raffey TM, Ryan RM. Neonatal Respiratory Distress secondary to Meconium Aspiration Syndrome. Children (Basel) 2021;8(3):246. https://doi. org/10.3390/children803246

Van Ierland Y, De Boer M, de Beaufort AJ. Meconium-stained amniotic fluid: discharge vigorous newborns. Arch Dis Child Fetal Neonatal Ed 2010;95(1):F69-F71.

Natatajan CK, Sankar MJ, Jain K, Agarwal R, Paul VK. Surfactant therapy and antibiotics in neonates with meconium aspiration syndrome: a systemic review and meta-analysis. J Perinatol 2016;36(Suppl 1):S49-S54. https://doi. org/10.1038/jp.2016.32

Kelly LE, Shivananda S, Murthy P, Srinivasjois R, Shah PS. Antibiotics for neonates born through meconium-stained fluid. Cochrane Database of Syst Rev 2017;6(6):CD006183.

Siriwachirachai T, Sangkomkamhang US, Lumbiganon P, Laopaiboon M. Antibiotics for meconium-stained amniotic fluid in labour for preventing maternal and neonatal infections. Cochrane Database of Syst Rev 2014; 2014(11):CD007772.

Morales P, Bustamante D, Espina-Marchant P. Pathophysiology of perinatal asphyxia: can we predict and improve outcomes. EPMA J 2011;2(2):211-230.

Vijlbrief D, Benders MJ, Kemperman H, van Bel F, de Vries WB. Use of cardiac biomarkers in neonatology. Pediatr Res 2012;72(4):337-343. https://

Bhatia P, Ela N. Fetal and neonatal outcome of babies in meconium-stained amniotic fluid and meconium aspiration syndrome. J Obstet Gynecol India 2007;57(6):501-504.

De Boer M, De Beaufort A. 79 value of postnatal hospital observation of children born through meconium-stained amniotic fluid. Pediatr Res 2005;58:368.

Prakash KP, Dinesh SBK. Respiratory distress in vigorous babies born through meconium-stained amniotic fluid: incidence, onset, risk factors and predictors

at birth. Int J Contemp Pediatr 2017;4:390-393.