MECONIUM ASPIRATION

SYNDROME
Introduction of meconium
The first intestinal discharge from newborns is
meconium, which is dark-green substance composed
of intestinal epithelial cells, lanugo, mucus and
intestinal secretions( eg. bile).
 Meconium is typically passed for 2-3 days after
birth.
Sometimes, the fetus passes the meconium while it
is still in the womb.
Intestinal secretions, mucosal cells and solid
elements of swallowed amniotic fluid are the major
solid constituents of meconium.
Definition of MAS

Meconium aspiration syndrome( MAS) is a

respiratory distress in a newborn who has
breathed( aspirated) meconium into the
lungs before or around the time of birth.
Causes of MAS
Hypoxia in distressed baby
Meconium Stained Liquor
Uterine Infections
Difficulty during labour
process
 Factors that promote the passage of meconium in
utero includes the following:
Placental insufficiency
Post dated pegnancy
Maternal hypertension
Pre-eclampsia
Oligohydramnios
Maternal drug abuse, especially of tobacco and cocaine
Maternal infection/ chorioamnioitis
Fetal distress
Inadequate removal of meconium from the airway prior to
the first breath.
Pathophysiology of MAS
Clinical features:
History
Presence of meconium in amniotic fluid.
Green urine may be observed in newborns with

meconium aspiration syndrome less than 24 hours

after birth. (Meconium pigments can be absorbed
by the lungs and can be excreted in urine).

Signs:
Severe respiratory distress may be present.
Symptoms include the following:
Cyanosis

End-expiratory grunting
Nasal flaring (nostrils widen while breathing)

Breathing problems like( difficulty in breathing,

no breathing and rapid breathing)

Tachypnea

Barrel chest in the presence of air trapping

rhonchi ( in some cases).

Yellow-green staining of fingernails, umbilical cord

and skin my be observed.
Diagnosis of MAS
High risk infants may be identified by
 fetal tachycardia
 bradycardia or
 absence of fetal accelerations (upon CTG ) in utero
 At birth, the infant may look cachexic and show signs
of yellowish meconium staining on skin, nail and the
umbillical cord.
 These infants usually progress onto Infant Respiratory
distress syndrome within 4 hours.
 Investigations which can confirm the diagnosis are :
Fetal chest x-ray, which will show
hyperinflation, diaphragmatic flattening,
cardiomegaly, patchy atelectasis and
consolidation.

ABG samples, which pH, partial pressure of

oxygen( p02), partial pressure of CO2 ( pCO2) and
continuous measurement of oxygenation by pulse
oximetry are necessary for management.
Complete blood count: hemoglobin & hematocrit
level must be sufficient to ensure adequate
oxygen- carrying capacity.
Serum electrolytes: obtain sodium, potassium
and calcium concentration when the infants with
MAS aged 24 hrs because the syndrome of
inappropriate secretion of antidiuretic
hormone( SIADH) and acute renal failure are
frequent complications of perinatal stress.
Preventive measures of MAS
MAS is difficult to prevent.
When there is meconium stained liquor, careful suctioning
of posterior pharynx after delivery of head decreases the
potential for aspiration of meconium.
When aspiration occurs, intubation immediate
and suctioning of airway can of aspirated
remove much meconium.
Do not perform the following harmful techniques in
an attempt to prevent aspiration of meconium- stained
liquor:
- Squeezing of the chest of baby
-Inserting a finger into the mouth of baby.
Management of MAS
Prenatal:
1. Identification of high risk pregnancies
- recognition of predisposing maternal factors
- post dates pregnancy inductions as early as 41 weeks
2. Monitoring
- careful observation and fetal monitoring during labour
- corrective measures should be undertaken in identifies
compromised fetus.
3. Amnioinfusion
-relieved umbilical cord compression during
labor -> reducing occurrence of variable fetal heart rate
decelerations
- efficiency not well demonstrated.
Delivery room management
Anticipate the worst….

Be prepared…
Immediate Management
 The American Academy of Pediatrics Resuscitation
Program
Neonatal Steering Committee guidelines are as follows
 If the baby is not vigorous:
 Suction the trachea immediately after delivery
 Suction for no longer than 5 seconds
 If no meconium is retrieved, do not repeat intubation and suction
 If meconium is retrieved and no bradycardia is present, reintubate
and suction
 If the heart rate is low, administer positive pressure ventilation and
consider suctioning again later.
 If the baby is vigorous:
Do not electively intubate
Clear secretions and meconium from the mouth and nose
with a
bulb syringe or a large-bore suction catheter.
 Dry, stimulate, reposition, and administer oxygen as necessary.
 Transfer ill newborns with respiratory distress to NICU
General management
 Continued care in the neonatal ICU (NICU)
 Maintain an optimal thermal environment
 Minimal handling to reduce agitation pulmonary
thus
hypertension and right-to-left shunting causing hypoxia
and acidosis
 Insert umbilical artery to monitor blood pH and blood
gases without agitating the infant.
 Continue respiratory care: oxygen therapy via hood or positive
pressure is crucial in maintaining adequate arterial
oxygenation. Oxygen saturation ( 90-95%) should
maintained. be
 Newborns are treated with antibiotics because of risk
of infection( eg. Gentamycin)
 Supportive treatment
o IV Dextrose to prevent hypoglycemia.
o Fluid restriction (60-70 mL/kg/d) to prevent
cerebral and pulmonary edema
o Electrolytes to correct metabolic acidosis
o Protein, lipids, and vitamins to prevent deficiencies

For treatment of persistent pulmonary

hypertension of newborn( PPHN), inhaled nitric
oxide is the pulmonary vasodilator of choice.
 Surfactant Therapy: Replace displaced or inactivated
surfactant and as a detergent to remove meconium, may reduce
the severity of disease, progression to extracorporeal
membrane oxygenation and decrease length of hospital stay.
May decrease respiratory failure with MAS within 6 hrs of 3
doses
Complications of MAS
In mild cases, respiratory distress usually subsides in
2-4 days although tachypnea can persist for longer.
Cerebral hypoxia may lead to long term neurological
damage.
Aspiration pneumonia
Brain damage due to lack of oxygen
Collapsed lung
Persistent pulmonary hypertension of newborn.
Prognosis of MAS
The mortality rate of meconium-stained infants is considerably
higher than that of non-stained infants.
Meconium aspiration accounts for a significant proportion of
neonatal deaths.
Residual lung problems are rare but include symptomatic
cough, wheezing, and persistent hyperinflation for up to five to
ten years.
The ultimate prognosis depends on the extent of CNS injury
from asphyxia and the presence of associated problems such as
persistent pulmonary hypertension.
 Mortality rate is approx 5%.
References
:Ranabhat, R.D & Niraula, H.(2017) A textbook of midwifery
& reproductive health (1st ed.). Kathmandu, Page no: 580-
582
Tuitui, R. (2016) Manual of midwifery III (11th ed.).
Vidyarthi
Pustak Bhandar, Kathmandu, Page no: 227-231
Dutta, D.C. (2011). A textbook of obstetrics including
perinatology and contraception (7th ed.). A central book
agency(P) ltd., Hyderabad, page no: 476