MECONIUM ASPIRATION

SYNDROME
Fetal & Infant Disease
 WHAT IS MAS?

• Meconium Aspiration Syndrome (MAS) is a

respiratory distress in a newborn who has
breath (aspirated) meconium into the
lungs before or around the time of birth.
• Meconium is sterile and does not contain bacteria, which is the
primary factor that differentiates it from a stool.
• As noted above, meconium-stained amniotic fluid may be
aspirated before or during labor and delivery; because
meconium is rarely found in the amniotic fluid prior to 34
weeks’ gestation, meconium aspiration primarily affects
infants born at term and post-term.
 CAUSES
• Placental insufficiency. When a mother has placental
insufficiency, there is a lack of adequate blood flow to
the baby, which can cause fetal distress, leading to the
untimely passage of meconium.
• Preeclampsia. When the placenta does not carry
adequate oxygen and nutrition for the fetus due to
maternal underperfusion such as preeclampsia, the
placental villi show increased syncytial knots, villous
agglutination, intervillous fibrin, and distal villous
hypoplasia, while maternal vessels in the decidua
disclose atherosis or mural hypertrophy of the
arterioles.
 CAUSES
• Maternal infection/chorioamnionitis. When the
placental membranes are ruptured and
amniotic fluid infection occurs, the placenta
shows acute chorioamnionitis (as the maternal
inflammatory response) and funisitis (as the
fetal inflammatory response).
• Fetal hypoxia. Fetal hypoxia leads to passage of
meconium from neural stimulation of a
maturing gastrointestinal system.
 DIAGNOSIS
• Acid-base status. Measurement of arterial blood
gas (ABG) pH, partial pressure of carbon
dioxide (pCO2), and partial pressure of oxygen
(pO2), as well as continuous monitoring of
oxygenation by pulse oximetry, are necessary for
appropriate management; the calculation of an
oxygenation index (OI) can be helpful when
considering advanced treatment modalities,
such as extracorporeal membrane oxygenation
(ECMO).
• Serum electrolytes. Obtain sodium, potassium, and
calcium concentrations at 24 hours of life in infants
with MAS, because syndrome of inappropriate
secretion of antidiuretic hormone (SIADH) and acute
renal failure are frequent complications of
perinatal stress.
• Complete blood cell count. Hemoglobin and
hematocrit levels must be sufficient to ensure
adequate oxygen-carrying capacity;
thrombocytopenia increases the risk for neonatal
hemorrhage; neutropenia or neutrophilia with
left shift of the differential may indicate perinatal
bacterial infection.
• Chest radiography. Chest radiography is essential
in order to confirm the diagnosis of meconium
aspiration syndrome (MAS) and determine the
extent of the intrathoracic pathology; identify
areas of atelectasis and air leak syndromes; ensure
appropriate positioning of the endotracheal tube
and umbilical catheters.
• Echocardiography. Echocardiography is necessary
to ensure normal cardiac structure and for
assessment of cardiac function, as well as to
determine the severity of
pulmonary hypertension and right-to-left
shunting.
 SIGNS AND SYMPTOMS
• Severe respiratory distress. Severe respiratory distress
may be present; symptoms include cyanosis, end-
expiratory grunting, nasal flaring, intercostal
retractions, tachypnea, barrel chest due to the presence
of air trapping, and in some cases, auscultated rales
and rhonchi.
• Staining of the fingernails. Yellow-green staining of
fingernails, umbilical cord, and skin may be also
observed.
• Green urine. Green urine may be noted in newborns
with MAS less than 24 hours after birth; meconium
pigments can be absorbed by the lung and can be
excreted in urine.
 NURSING INTERVENTION
INDEPENDENT:
• Reduce body temperature. Provide TSB to help lower
down the temperature; ensure that all equipment
used for the infant is sterile, scrupulously clean; do
not share equipment with other infants to prevent
the spread of pathogens, and administer antipyretics
as ordered.
• Improve fluid volume level. Monitor and record vital
signs to note for alterations; provide oral care by
moistening lips & skin care by providing daily bath;
administer IV fluid replacement as ordered to replace
fluid losses.
• Increase tissue perfusion. Note quality and strength of
peripheral pulses; assess respiratory rate, depth, and
quality; assess skin for changes in color, temperature,
and moisture; elevate affected extremities with edema
once in a while to lower oxygen demand.
• Improve frequency of breastfeeding. Demonstrate the
use of manual piston-type breast pump.; review
techniques for storage/use of expressed breast milk;
provide privacy, calm surroundings when the mother
breastfeeds; recommend for infant sucking on a
regular basis, and encourage the mother to obtain
adequate rest, maintain fluid and nutritional intake,
and schedule breast pumping every 3 hours while
awake.
• Improve infant-parent
relationship. Educate parents regarding
child growth and development, addressing
parental perceptions; involve parents in
activities with the newborn that they can
accomplish successfully, and recognize and
provide positive feedback for nurturing
and protective parenting behaviors.
 NURSING INTERVENTION
COLLABORATIVE:
• Cardiac exam. In patients with meconium aspiration
syndrome (MAS), a thorough cardiac examination and
echocardiography are necessary to evaluate for congenital
heart disease and persistent pulmonary hypertension of the
newborn (PPHN).
• Diet. Intravenous fluid therapy begins with adequate
dextrose infusion to prevent hypoglycemia. Intravenous
fluids should be provided at mildly restricted rates (60-70
mL/kg/day).
 Progressively add electrolytes, protein, lipids, and
vitamins to ensure adequate nutrition and to prevent
deficiencies of essential amino acids and essential fatty
acids.
 NURSING INTERVENTION
DEPENDENT:
• Surfactant therapy. Surfactant therapy is commonly used
to replace displaced or inactivated surfactant and as a
detergent to remove meconium; although surfactant use
does not appear to affect mortality rates, it may reduce
the severity of disease, progression to extracorporeal
membrane oxygenation (ECMO) utilization, and decrease
the length of hospital stay.
• IV fluids. Intravenous fluid therapy begins with adequate
dextrose infusion to prevent hypoglycemia; intravenous
fluids should be provided at mildly restricted rates (60-70
mL/kg/day).
• Respiratory gases. Inhaled nitric oxide (NO)
has the direct effect of pulmonary
vasodilatation without the adverse effect of
systemic hypotension; it is approved for use if
concomitant hypoxemic respiratory failure
occurs.
• Systemic vasoconstrictors. These agents are
used to prevent right-to-left shunting by
raising systemic pressure above pulmonary
pressure; systemic vasoconstrictors include
dopamine, dobutamine, and epinephrine;
dopamine is the most commonly used.
• Sedatives. These agents maximize the
efficiency of mechanical ventilation,
minimize oxygen consumption, and treat
the discomfort of invasive therapies.
• Neuromuscular blocking agents. These
agents are used for skeletal muscle
paralysis to maximize ventilation by
improving oxygenation and ventilation;
they are also used to reduce barotrauma
and minimize oxygen consumption.