A lung infection that develops in an infant born through Meconium stained amniotic fluid after

having aspirated meconium into the lungs.

One of the most common causes of severe respiratory failure in infants born at term, post-term
infants and infants who are small for gestational age.

The risk of MSAF is strongly correlated with gestational age.

Before 37 weeks of gestation, the risk of MSAF is less than 2%, whereas
the risk after 42 weeks of gestation is nearly 44%.

Meconium: the first intestinal discharge of a newborn

The passage of meconium in utero, the meconium-stained amniotic fluid may be aspirated

Normally the passage of meconium from the fetus into amnion is prevented by lack of peristalsis
(low motilin level), tonic contraction of the anal sphincter, terminal cap of viscous meconium.
• Fetal maturation post term (high motilin level)
• Vagal stimulation by cord or head compression in absence of fetal distress.
• In utero stress (hypoxia, acidosis) producing relaxation of anal sphincter.

As the fetus approaches term, the GI tract matures, and vagal stimulation from head or spinal cord
compression may cause peristalsis and relaxation of the rectal sphincter, leading to meconium
passage.
It is possible that the passage of meconium in utero is the result of transient parasympathetic
stimulation from cord compression in a neurologically mature fetus.
Passage of meconium in utero is a natural phenomenon that reflects the maturity of the
gastrointestinal tract.
• Meconium is aspirated into the tracheobronchial tree when the fetus begins to gasp deeply
in response to hypoxia and acidosis.
• If meconium is not removed from the trachea after delivery, with the onset of respiration it
migrates from the central airways to the periphery of the lung.
• Hyperinflation & Patchy atelectasis
• Accumulation of proteinaceous debris within the alveolus.
• Initially, particles of meconium produce mechanical obstruction of the small airways that
results in hyperinflation with patchy atelectasis.
• Later, small airway obstruction is the result of chemical pneumonitis and interstitial edema
which is due to the pulmonary vasculature being compromised and the pulmonary HPN
(elicited by hypoxia).
• During this later stage, hyperinflation persists, and areas of atelectasis become more
extensive.

Treatment of MAS includes supportive care and standard management for respiratory distress •
Endotracheal intubation and suction to remove meconium from the airway before the 1st breath in
the delivery room is essential • In infants with clinical signs of respiratory failure; oxygen saturation
by pulse oximetry, ABG and a CXR should be obtained as soon as possible.
Meconium directly alters the amniotic fluid, reducing antibacterial activity and subsequently
increasing the risk of perinatal bacterial infection. Because of the difficulty in diagnosing a
superimposed infection, many clinicians elect to treat these infants with antibiotics until the acute
respiratory failure subsides
Administration of exogenous surfactant/ inhaled NO to infants with MAS and hypoxemic respiratory
failure/ pulmonary hypertension requiring mechanical ventilation decreases the need for ECMO
support • Because meconium aspiration can inactivate alveolar surfactant, the administration of
exogenous surfactant or even pulmonary lavage with a surfactant solution sometimes can be
beneficial • Inhaled nitric oxide is the pulmonary vasodilator of choice

Continuous positive airway pressure (CPAP) is a type of positive airway pressure that is used to
deliver a set pressure to the airways that is maintained throughout the respiratory cycle, during
both inspiration and expiration. CPAP when applied early may reduce the need for MV in newborns
with moderate to severe MAS infants. Babies born with meconium-stained amniotic fluid (MSAF)
are hundred fold more likely to develop substantial respiratory distress than those born with clear
amniotic fluid

In extracorporeal membrane oxygenation (ECMO), blood is pumped outside of your body to a

heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in
the body. Blood flows from the right side of the heart to the membrane oxygenator in the heart-lung
machine, and then is rewarmed and sent back to the body.

This method allows the blood to "bypass" the heart and lungs, allowing these organs to rest and
heal.

These infants often require high peak inspiratory pressures to maintain adequate ventilation and
oxygenation • In infants with MAS who develop complications (like pneumothorax) require
mechanical ventilation • Patients with MAS who are refractory to conventional mechanical
ventilation may benefit from HFV (High frequency ventilation) or ECMO (Extracorporeal membrane
oxygenation)