Abstract
Background Meconium observed in the amniotic fluid during delivery may warrant clinical monitoring due to potential neonatal complications. This study aimed to assess the incidence, risk factors, and outcomes associated with meconium aspiration syndrome (MAS) in neonates born through meconium-stained amniotic fluid (MSAF) at a rural tertiary care center in India. Materials and methods A prospective observational study was conducted over 18 months in the neonatal intensive care unit (NICU) of a rural tertiary hospital. A total of 126 inborn neonates with MSAF were enrolled. Maternal and neonatal demographic, clinical, and outcome data were collected. Statistical analyses included chi-square tests and Pearson's correlation for univariate associations, and multivariable logistic regression was used to identify independent predictors of MAS and related outcomes. A p-value <0.05 was considered statistically significant. Results The incidence of MAS among neonates born through MSAF was 31.8% (40/126). The independent predictors of MAS included multigravida status (odds ratio [OR] = 3.633; p = 0.012), post-term gestation (OR = 4.126; p = 0.040), and maternal comorbidities (OR = 0.189; p = 0.003). MAS significantly predicted the need for resuscitation (OR = 0.038; p < 0.001), oxygen therapy (OR = 0.009; p < 0.001), shock (OR = 0.023; p < 0.001), acute kidney injury (AKI) (OR = 0.089; p < 0.001), persistent pulmonary hypertension of the newborn (PPHN) (OR = 0.019; p < 0.001), and hypoxic-ischemic encephalopathy (HIE) (OR = 0.028; p < 0.001). Abnormal creatinine-phosphokinase myocardial band (CPK-MB) levels (OR = 34.0; p < 0.001), abnormal chest X-ray findings (OR = 64.8; p < 0.001), and increased NICU stay (OR = 0.129; p < 0.001) were also strongly associated. Neonatal mortality was significantly higher among MAS cases (OR = 4.703; p = 0.009). Conclusion MAS remains a significant contributor to neonatal morbidity and mortality in low-resource settings. Early identification of at-risk neonates, improved targeted intrapartum monitoring, and timely resuscitative efforts are crucial. Integration of standardized MAS risk assessment protocols, strengthening emergency obstetric and newborn care (EmONC) infrastructure, and implementing regular staff training at all healthcare levels are urgently needed. Multicentric validation studies should also be prioritized to guide evidence-based interventions and reduce MAS-related complications in low-resource settings.