Role of antibiotics in meconium aspiration syndrome

Background: Meconium aspiration syndrome (MAS) is a major cause of severe respiratory distress in newborns and the role of antibiotics in its management is not well defined. Objective: To determine the role of routine antibiotic therapy in the management of MAS. Methods: After excluding the possibility of sepsis, 144 patients with MAS were randomised into two groups. Group A (study group) received ampicillin and gentamicin for 7 days, commencing between 24 and 36 hours of life, and group B, the controls, received no antibiotics. Both groups received similar supportive management. The primary outcome measure was the development of infection. Details of clinical progress during hospitalisation were recorded. All were followed up for a minimum of 3 months. Results: The patient profiles were similar in both groups. Five patients (three in the study group, two controls) developed culture-positive sepsis during their hospital stay. No significant difference was detected between the groups regarding period of oxygen dependency (5.8 vs 5.9 days), day of starting feeds (4.0 vs 4.2), day of achievement of full feeds (9.4 vs 9.3), clearance of chest radiograph (11.7 vs 12.9 days) or duration of hospital stay (13.7 vs 13.5 days). The most common radiological features were parenchymal infiltrates followed by hyperinflation. The incidence of complications was similar in both groups. Conclusion: Routine antibiotic therapy is not necessary for managing MAS.