Meconium

Aspiration
Syndrome
Castillano, Larang, Ma, Solaiman
Post Graduate Interns
TABLE OF CONTENTS

01 Case Discussion
02 Diagnosis

03 04
Management Journal Update
01
Case Discussion
Meconium Aspiration Syndrome

10–15% Meconium aspiration 30 %

-Meconium-stained syndrome -require mechanical
amniotic fluid -develops in 5% of such ventilation
-Term or postterm infants infants;
Pathophysiology-Meconium Aspiration Syndrome
Neonatal Sepsis

Early
onset of symptoms before 7
days of age

Late
onset of symptoms at ≥7
days of age

Very Late
onset after age 1 mo

Incidence
varies from 1-4 per 1, 000
Pathophysiology- Early Onset Neonatal Sepsis

Chorioamnionitis

● intrauterine inflammation or infection at birth

● results from microbial invasion of amniotic fluid, often as a result of prolonged rupture of
the chorioamniotic membrane
● defined by fetal tachycardia, maternal leukocytosis (>15,000 cells in the absence of
corticosteroids), purulent fluid from the cervical os, biochemical or microbiologic
amniotic fluid changes consistent with infection, and fever (≥39.0°C/10.2°F)
02
DIAGNOSIS
Meconium Aspiration Syndrome
Neonatal Sepsis
Meconium Aspiration Syndrome:
CLINICAL MANIFESTATIONS

Intrapartum or Intra uterine Small Airway Obstruction

Aspiration of thick
Respiratory DIstress
meconium Tachypnea, retrations, grunting and cyanosis
Pneumomediastinum, Pneumothorax
Term or Post Term Overdistention of the chest
Infant Usually improves within 72
hours or mah require assisted
ventilation
CHEST RADIOGRAPH

Patchy infiltrates
Coarse streaking
Increased AP diameter
Flattening of the diaphragm

Image from Radiopedia.org.

NEONATAL SEPSIS:
CLINICAL MANIFESTATIONS

Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 129.

NEONATAL SEPSIS: Evaluation of a newborn
for infection or sepsis

MATERNAL AND BIRTH EVIDENCE OF OTHER EVIDENCE OF FOCAL

HISTORY DISEASES OR SYSTEMIC DISEASE

LABORATORY EVIDENCE OF EVIDENCE OF MULTI

STUDIES INFLAMMATION ORGAN SYSTEM
DISEASE
Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 129.
03
Management
Meconium Aspiration Syndrome
Neonatal Sepsis
Meconium Aspiration Syndrome
PREVENTION:
● Rapid identification of fetal distress
● Initiation of prompt delivery in the presence of late FHR decelaration or poor beat to beat variability

TREATMENT:
● Supportive care and standard management for respiratory distress
● Mean airway pressure on oxygenation
● Exogenous surfactant and or iNO
● HFV or ECMO

Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 122.8 Meconium Aspiration.
Neonatal Sepsis
● Empirical regimen for suspected early-onset sepsis in a term or late preterm infant:
○ Ampicillin - 150 mg/kg/dose IV every 12 hr
○ Gentamicin - 4 mg/kg/dose IV every 24 hr
● Patients presents with infection after discharge from nursery, or when ampicillin-
resistant E. coli is suspected:
○ Ampicillin plus Cefotaxime or Cefepime may be substituted
● Premature infants >41 wk postconception age, or term infants not receiving IV calcium,
or do not have hyperbilirubinemia
○ Ceftriaxone may be substituted
● Suspected infection with S. aureus
○ Vancomycin substituted for ampicillin

Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 129 Epidemiology of Infections.
Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 129 Epidemiology of Infections.
Prognosis
Meconium Aspiration Syndrome
● Mortality rate is considerably higher than that of non stained infants
● Residual lung problems are rare
● Ultimate prognosis depends on extent of CNS injury from asphyxia and associated problems
such as pulmonary hypertension

Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition. Chapter 122.8 Meconium Aspiration.
JOURNAL
UPDATE
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REFERENCES

● Kliegman, et al. Nelson Textbook of Pediatrics, 21st Edition.

● Radiopedia.org
● Natarajan etl al (2016). Surfactant therapy and antibiotics in neonates with
meconium aspiration syndrome: a systematic review and meta-analysis.
Journal of Perinatology. 36, pagesS49–S54(2016)