Analysis of influencing factors and prediction model construction of meconium aspiration syndrome in full-term neonates

ObjectiveTo explore the influencing factors of meconium aspiration syndrome (MAS) in full-term neonates and construct a prediction model.

MethodsThe data of 507 full-term neonates and mothers with meconium-contaminated amniotic fluid detected by prenatal examination from March 2018 to May 2021 were retrospectively analyzed.According to whether MAS occurred within 3 days after birth, they were divided into MAS group and non-MAS group.The related indexes of the two groups were compared.Multivariate logistic regression analysis was performed.A prediction model was established.ROC curve was used to analyze the model discrimination.The goodness of fit was used to test the model calibration.A total of 184 full-term neonates with meconium-contaminated amniotic fluid from July 2021 to March 2022 were selected as the clinical verification of the model.

ResultsThere were 62 cases (12.23%) of MAS in 507 full-term neonates with meconium-contaminated amniotic fluid.The fetal distress, gestational age of delivery, mode of delivery, amniotic fluid pollution, neonatal umbilical cord blood pH value and neonatal Apgar 1 min score were independent influencing factors of MAS in full-term neonates (P < 0.05 to P < 0.01).The prediction model equation was constructed as follows: Logit (P)=0.704×fetal distress (0=no; 1=yes)+0.625×gestational age at delivery (measured value)+0.443×mode of delivery (0=natural birth; 1=cesarean section) +1.267×amniotic fluid pollution index (0=degree Ⅰ; 1=Ⅱ degree; 2=degree Ⅲ)+0.694×neonatal umbilical cord blood pH value (measured value) +0.783×neonatal Apgar 1 min score (measured value)-27.894.The area under the ROC curve was 0.877 (95%CI: 0.828-0.927).The sensitivity and specificity of the maximum Youden index (0.736) were 88.70% and 84.60%, respectively.Goodness of fit test showed χ²=1.13, P>0.05, indicating that there was no over-fitting phenomenon in the model.After clinical verification, the sensitivity of the model was 87.50%, specificity was 85.63%, and accuracy rate was 85.87%.

ConclusionsThe influencing factors of neonatal MAS in full-term pregnant women are fetal distress, gestational age, cesarean section, amniotic fluid pollution, neonatal umbilical cord blood pH value, and neonatal Apgar 1 min score.A prediction model is constructed based on above, which is well distinguished and has high prediction efficacy.