MECOCIUM ASPIRATION

SYNDROME
Written by: Dr. Prithwiraj Maiti, R.G.Kar Medical College
Resources used: Nelson’s Pediatrics, Rudolph’s Pediatrics, CMDT
of Pediatrics and IAP Textbook of Pediatrics
 CONTENT
S
• INTRODUCTION
• RISK FACTORS
• PATHOPHYSIOLOGY
• CLINICAL
PRESENTATION
• DIAGNOSTIC TOOLS
• DIFFERENTIAL
DIAGNOSIS
• COMPLICATIONS
• MANAGEMENT
• PREVENTION
• PROGNOSIS
 INTRODUCTIO
N
• Meconium aspiration syndrome (MAS) is one of the most common causes
of severe respiratory failure in infants born at term/ post-term gestation.
• Meconium is the first stool of an infant, composed of materials ingested
during the period of gestation.
• Meconium is normally stored in the infant's intestines until after birth, but
sometimes (often in response to fetal distress and hypoxia) it is expelled
into the amniotic fluid prior to birth, or during labor. If the baby then
inhales the meconium, MAS may o ccur.
• Meconium is present in the amniotic fluid in approximately 10-15% of all
term deliveries, but MAS occurs in fewer than 1/3rd of these infants.
 RISK
FACTORS
Maternal risk factors includes all which induce fetal distress and
hypoxia:
1. Preeclampsia,
2. Hypertension,
3. Oligohydramnios,
4. Maternal infections,
5. Maternal drug use,
6. Placental insufficiency,
7. Intrauterine growth restriction.
PATHOPHYSIOLOGY
 CLINICAL
PRESENTATION
HISTORY:
MAS o ccurs most frequently in term/ post-term infants
who:
1. Have a history of fetal distress
2. Have a low APGAR score at birth and
3. Have meconium stained amniotic fluid at birth.
 CLINICAL
PRESENTATION
SIGNS AND SYMPTOMS:
1. Meconium stained skin, nails and umbilical cord
2. Signs of respiratory distress develop usually within the 1st hour of birth:
A. Tachypnoea,
B. Intercostal retractions,
C. Coarse bronchial sounds,
D. Expiratory grunting, and/or
E. Cyanosis.
3. Chest may be overinflated/ barrel shaped, with a protruding sternum
(due
to obstructive emphysema).
 DIAGNOSTIC
TOOLS
• CXR: Often reveals-
1. Bilateral patchy areas of increased density,
2. Sometimes confluent and alternating with hyperlucent areas;
3. Increased anteroposterior diameter, and
4. Flattening of the diaphragm.

• ABG in first hour of birth: Often reveals evidences of perinatal

asphyxia-
1. Hypoxemia and
2. Some degree of metabolic a cidosis.
DIAGNOSTIC
TOOLS
CXR from an infant with
severe MAS showing
bilateral patchy areas of
increased density
 DIFFERENTIAL
DIAGNOSIS
• A normal CXR in an infant with severe hypoxemia and no
cardiac malformation suggests the diagnosis of pulmonary
hypertension.
 COMPLICATIONS
• Pneumothorax
• Persistent pulmonary hypertension of the newborn
• Secondary bacterial infection of the lungs
• Subglottic stenosis (secondary to the extended presence of the
endotracheal tube in patients requiring mechanical
ventilation).
 COMPLICATIONS
Development of a left tension
pneumothorax in an infant with
MAS
 MANAGEMENT
• 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
• 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
 MANAGEMENT
• 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
• Because of the difficulty in diagnosing a superimposed infection, many
clinicians elect to treat these infants with antibiotics until the acute
respiratory failure subsides
• Most of these infants are hyperactive and restless, it is often necessary to
use sedation or even neuromuscular blockade, at least during the first 24-
48 hours of mechanical ventilation, until the infant is stable and the peak
airway pressure can be reduced.
 PREVENTIO
N
• When meconium appears in the amniotic fluid or is present in the upper
airway at the time of birth, the first concern should be to reduce the risk
of aspiration of the meconium into the more distal air spaces and
thereby prevent the subsequent pulmonary involvement
• The recommended approach is to suction the nasopharynx with a
large catheter or a suction bulb
• Infants with previous intrapartum asphyxia and meconium aspiration
should receive 100% oxygen immediately after birth in order to increase
arterial oxygenation and reverse the pulmonary hypertension that
accompanies hypoxemia and acidosis
• Most clinicians still recommend early suctioning of the nasopharynx when
there is any evidence of meconium in the amniotic fluid with the purpose
of reducing the risk of aspiration of this material into the lower airways.
 PROGNOSI
S
• The mortality rate of meconium-stained infants is considerably higher than
that of non-stained infants. The decline in neonatal deaths due to MAS
during the last decades is related to improvements in obstetric and
neonatal care.
• Although most infants with MAS survive without sequelae, long-term
follow- up studies have demonstrated an increased prevalence of
neurologic sequelae most likely associated with perinatal asphyxia.
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