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Mekanismo [baguhin]
Ang pathophysiology ng MAS ay dahil sa isang kumbinasyon ng mga pangunahing surfactant
kakulangan at surfactant inactivation bilang isang resulta ng plasma protina pagtulo sa
airways mula sa mga lugar ng epithelial pagkagambala at pinsala. [4]
Diagnosis [baguhin]
Mataas na panganib mga sanggol ay maaaring ay makikilala sa pamamagitan pangsanggol
tachycardia, bradycardia o kawalan ng pangsanggol accelerations sa CTG sa utero, sa
kapanganakan ng sanggol ay maaaring tumingin cachexic at ipakita ang mga palatandaan
ng madilaw-dilaw na meconium staining sa balat, kuko at ang umbillical cord, ang mga
sanggol ay karaniwang pagsulong papunta Infant respiratory syndrome pagkabalisa sa loob
ng 4 na oras. Pagsisiyasat na maaaring kumpirmahin ang diagnosis ay pangsanggol dibdib x-
ray, na magpapakita sa hyperinflation, diaphragmatic pagyupi, cardiomegaly, tagpi-tagpi
atelectasis at pagpapatatag, at ABG sample, na kung saan ay magpapakita nabawasan
antas ng oxygen.
Prevention [baguhin]
MAS ay mahirap na maiwasan. [Banggit kailangan] Amnioinfusion, ang isang paraan ng
paggawa ng malabnaw makapal meconium na lumipas sa amniotic likido sa pamamagitan
pumping ng sterile fluid sa amniotic fluid, ay hindi ipinapakita ng isang benepisyo. [6] [7]
Paggamot [baguhin]
Surfactant ay lilitaw upang mapabuti ang kinalabasan kapag ibinigay sa mga sanggol sundin
meconium lunggati. [8]
Puti ng itlog-lavage Matagal nang hindi nagpakita upang makinabang kinalabasan ng MAS.
[10] Steroid paggamit ay hindi nagpakita upang makinabang ang mga kinalabasan ng MAS.
[11]
Pagbabala [baguhin]
Ang dami ng namamatay rate ng meconium-stained sanggol ay malaki mas mataas kaysa
sa na ng mga di-marumi sanggol; meconium lunggati ginagamit upang account para sa
isang makabuluhang bahagdan ng neonatal pagkamatay. Nalalabing mga problema sa baga
ay bihirang ngunit isama nagpapakilala ubo, wheezing, at paulit-ulit hyperinflation para sa
hanggang sa limang sa sampung taon. Ang tunay na pagbabala ay depende sa lawak ng
CNS pinsala mula asphyxia at ang pagkakaroon ng mga kaugnay na mga problema tulad ng
baga Alta-presyon. Limampung porsiyento ng newborns apektado ng meconium lunggati
mamamatay labinlimang taon na ang nakaraan; gayunpaman, ngayon ang porsiyento ay
bumaba sa tungkol sa dalawampung. [2]
Epidemiology [baguhin]
Sa isang pag-aaral na isinasagawa sa pagitan ng 1995 at 2002, MAS naganap sa 1,061 ng
2,490,862 live births, na sumasalamin sa isang saklaw ng 0.43 ng 1,000. MAS
nangangailangan intubation ay nangyayari sa mas mataas na mga rate sa pregnancies
lampas 40 na linggo. 34% ng lahat ng kaso MAS ipinanganak pagkatapos ng 40 linggo
kinakailangan intubation kung ihahambing sa 16% bago ang 40 linggo. [12]
Specialty pediatrics
ICD-10 P24.0
ICD-9-CM 770.11, 770.12
DiseasesDB 7907
MedlinePlus 001596
eMedicine ped/768
MeSH D008471
[edit on Wikidata]
Contents
[hide]
2Causes
3Mechanism
4Diagnosis
5Prevention
6Treatment
7Prognosis
8Epidemiology
9See also
10References
11External links
Signs and symptoms[edit]
The most obvious sign that meconium has been passed during or before labor is the greenish or
yellowish appearance of the amniotic fluid. The infant's skin, umbilical cord, or nailbeds may be
stained green if the meconium was passed a considerable amount of time before birth. These
symptoms alone do not necessarily indicate that the baby has inhaled in the fluid by gasping in utero
or after birth. After birth, rapid or labored breathing, cyanosis, slow heartbeat, a barrel-shaped chest
or low Apgar score are all signs of the syndrome. Inhalation can be confirmed by one or more tests
such as using a stethoscope to listen for abnormal lung sounds (diffuse 'wet' crackles and rhonchi),
performing blood gas tests to confirm a severe loss of lung function (respiratory acidosis as a
consequence of hypercapnia), and using chest X-rays to look for patchy or streaked areas on the
lungs. Infants who have inhaled meconium may developrespiratory distress syndrome often
requiring ventilatory support. Complications of MAS include pneumothorax and persistent pulmonary
hypertension of the newborn.
Causes[edit]
Fetal distress during labor causes intestinal contractions, as well as relaxation of the anal sphincter,
which allows meconium to pass into the amniotic fluid and contaminate the amniotic fluid. Meconium
passage into the amniotic fluid occurs in about 520 percent of all births and is more common in
overdue births. Of the cases where meconium is found in the amniotic fluid, meconium aspiration
syndrome develops less than 5 percent of the time. [1] Amniotic fluid is normally clear, but becomes
greenish if it is tinted with meconium.
Maternal risk factors can include: preeclampsia, maternal hypertension, oligohydramnios, maternal
infections, maternal drug use, placental insufficiency, and/or intrauterine growth restriction. [2]
The risk of MAS increases after the 40th week of pregnancy.[3]
Mechanism[edit]
The pathophysiology of MAS is due to a combination of primary surfactant deficiency and surfactant
inactivation as a result of plasma proteins leaking into the airways from areas of epithelial disruption
and injury.[4]
The leading three causes of MAS are
Diagnosis[edit]
High risk infants may be identified by fetal tachycardia, bradycardia or absence of fetal
accelerations upon CTG in utero, at birth the infant may look cachexic and show signs of
yellowish meconium staining on skin, nail and the umbillical cord, these infants usually progress
onto Infant Respiratory distress syndrome within 4 hours. Investigations which can confirm the
diagnosis are fetal chest x-ray, which will show hyperinflation, diaphragmatic flattening,
cardiomegaly, patchy atelectasis and consolidation, and ABG samples, which will show
decreased oxygen levels.
Prevention[edit]
MAS is difficult to prevent.[citation needed] Amnioinfusion, a method of thinning thick meconium that has
passed into the amniotic fluid through pumping of sterile fluid into the amniotic fluid, has not
shown a benefit.[6][7]
Treatment[edit]
Surfactant appears to improve outcomes when given to infants follow meconium aspiration. [8]
It has been recommended that the throat and nose of the baby be suctioned as soon as the
head is delivered. However, this is not really useful and the revised Neonatal Resuscitation
Guidelines no longer recommend it.[citation needed] When meconium staining of the amniotic fluid is
present and the baby is born depressed, it is recommended that an individual trained in neonatal
intubation use a laryngoscope and endotracheal tube to suction meconium from below the vocal
cords.[citation needed] If the condition worsens,extracorporeal membrane oxygenation (ECMO) can be
useful.[9]
Albumin-lavage has not demonstrated to benefit outcomes of MAS. [10] Steroid use has not
demonstrated to benefit the outcomes of MAS.[11]
Prognosis[edit]
The mortality rate of meconium-stained infants is considerably higher than that of non-stained
infants; meconium aspiration used to account for a significant proportion of neonatal deaths.
Residual lung problems are rare but include symptomatic cough, wheezing, and persistent
hyperinflation for up to five to ten years. The ultimate prognosis depends on the extent of CNS
injury from asphyxia and the presence of associated problems such as pulmonary hypertension.
Fifty percent of newborns affected by meconium aspiration would die fifteen years ago; however,
today the percent has dropped to about twenty.[2]
Epidemiology[edit]
In a study conducted between 1995 and 2002, MAS occurred in 1,061 of 2,490,862 live births,
reflecting an incidence of 0.43 of 1,000. MAS requiring intubation occurs at higher rates in
pregnancies beyond 40 weeks. 34% of all MAS cases born after 40 weeks required intubation
compared to 16% prior to 40 weeks.[12]