Clinical, Radiological Profile, Risk Factors, and Short-Term Outcomes of Meconium Aspiration Syndrome Among Neonates at Two Referral Hospitals in Uganda

Meconium Aspiration Syndrome (MAS) is a significant contributor to neonatal morbidity and mortality, particularly in low-resource settings. Despite its clinical relevance, limited local data exist on the burden of MAS, clinical and radiological profile, associated risk factors, and short-term outcomes in Uganda. This study aimed to describe the clinical and radiological features, determine the proportion of neonates with MAS and its risk factors among neonates admitted to two regional referral hospitals in Uganda. A prospective cohort study was conducted among 125 neonates at Mubende and Fort Portal Regional Referral hospitals between June and August 2025. Neonates were consecutively enrolled and followed for up to 14 days of life. Data was collected using a structured tool covering clinical features, radiological findings, maternal and perinatal factors, and outcomes. Descriptive statistics summarized baseline characteristics and outcome proportions, while multivariate Poisson regression identified factors independently associated with MAS. Adjusted Incidence Rate Ratios (aIRR) and 95% Confidence Intervals (CI) were reported. Clinically, neonates most frequently presented with nasal flaring 23 (18.4%), tachypnoea 21(16.8%), chest retractions 19(15.2%), cyanosis 18(14.4%), and grunting 12(9.6%), wheezing 13 (10.4%), crackles 11 (8.8%). Radiological features included hyperinflation 6(4.8%), bilateral infiltrates 5(4.0%), and atelectasis 4(3.2%). Independent predictors of MAS included maternal age ≥35 years (aIRR = 2.09), pregnancy-induced diabetes mellitus (aIRR = 2.77, p = 0.04), fetal distress (aIRR = 3.97, p < 0.001), and a low 5th minute APGAR score of 0–3 (aIRR = 1.94, p = 0.03). In-hospital deaths (P = 0.002) and length of hospital stay (P < 0.001) were significantly associated with MAS among neonates in the study area. MAS remains a critical neonatal condition with a significant risk of mortality and prolonged hospitalization in Uganda. Advanced maternal age, gestational diabetes, fetal distress, and low APGAR scores were key predictors. Strengthening antenatal surveillance, improving intrapartum monitoring, and ensuring early neonatal resuscitation are essential to reduce the burden of MAS in resource-limited settings.