MECONIUM

ASPIRATION
• Meconium- first intestinal discharge from newborns
- a viscous, dark-green substance composed of intestinal epithelial cells, lanugo,
mucus, and intestinal secretions
- sterile and does not contain bacteria, which is the primary factor that
differentiate it from stool.
• Meconium-stained amniotic fluid
- found in 10 – 15% of births
- usually occurs in term and postterm infants
• Meconium Aspiration Syndrome (MAS)
- aspiration of stained amniotic fluid
- develops in 5% of such infants; 30% require mechanical ventilation; 3-5% die
Usually, but not invariably, Fetal distress and Hypoxia occur before the passage of meconium into
the amniotic fluid.
PATHOPHYSIOLOGY OF MAS
CLINICAL MANIFESTATIONS

• Thick particulate meconium is aspirated into the lungs

• Small airway obstruction
-within first few hours: produce respiratory distress
-severely affected infants: tachypnea, retractions, grunting, and cyanosis
• Partial obstruction of some airways
-lead to pneumomediastinum, pneumothorax or both
• Over distention of chest maybe prominent
• Condition usually improves within 72 hours
• Course requires assisted ventilation, maybe severe with a high risk for mortality
• Tachypnea- persist for many days or even several weeks
• Chest Radiograph: patchy infiltrates, coarse streaking of both lung fields, increased
anteroposterior diameter, and flattening diaphragm
 PREVENTION

-rapid identification of fetal distress

-initiation of prompt delivery in the presence of late fetal heart rate
deceleration or poor beat-to-beat fetal heart rate variability
-amniotransfusion does not reduce the risk
-intrapartum nasopharyngeal suctioning in infants with meconium-
stained amniotic fluid does not redce risk
 TREATMENT

• Depressed infants may benefit from endotracheal intubation and suction to remove
meconium from airway before first breath in delivery room
• Supportive care
• Standard management for respiratory distress
• Exogenous surfactant and/or iNO to infants with MAS and hypoxemic respiratory failure or
pulmonary hypertension requiring mechanical ventilation, decreases the need for ECMO
• Px that is refractory to conventional mechanical ventilation may benefit from HFV or
ECMO
 PROGNOSIS

• Mortality rate: higher than nonstained infants

• Decline in neonatal deaths during the last decades is related to improvements
in obstetric and neonatal care
• Symptomatic cough, wheezing, persistent hyperinflation for up to 5-10 years
• Ultimate prognosis depends on extent of CNS injury from asphyxia and
presence of assoc. problems such as pulmonary hypertension