Serum Enzymes in Predicting the Severity of Meconium Aspiration Syndrome in Newborn

Purpose: Meconium aspiration syndrome (MAS), often progresses to respiratory failure and its’ serious com­ plication, persistent pulmonary hypertension of the newborn (PPHN) is a major cause of neonatal mortality. Early recognition of infants at the risk for respiratory failure in MAS patients is necessary for treatment. So we aimed to identify serum enzymes such as lactate dehydrogenase (LDH), aspartate transaminase (AST), and alanine transaminase (ALT) as serum biologic marker for early detection of respiratory failure in MAS patients. Methods: Infants admitted within 24 hours after birth to Neonatal Intensive Care Unit of Dongguk University Ilsan Hospital and diagnosed with MAS from August 2005 to March 2014 were analyzed retrospectively. Serum enzymes were measured on admission. Results: Of the total 60 patients diagnosed with MAS, 28 were in the positive pressure ventilation (PPV) group and 32 were in the non­PPV group. Six patients progressed to PPHN. Only serum LDH was significantly higher in the PPV group than the non­PPV group (median 1,123 vs. 831, P=0.01). Using the ROC curves, the cut­off value of 964 U/L for LDH offered the best predictive value for PPV requirement (sensitivity 61% and specificity 81%). Serum LDH was significantly higher in MAS with PPHN group than MAS without PPHN group (median 1,791 vs. 904, P=0.013). But serum AST, ALT were not predicting factor for the requirement of respiratory support and development of PPHN among MAS patients. Conclusion: LDH might be a good predicting factor for the requirement of respiratory support and develop­ ment of PPHN among MAS patients.