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aspiration syndrome
Incidence
Consequences
Diagnosis
Treatment
Key Points
References
Incidence
Meconium can be found in the gastrointestinal tracts of fetuses as early as 14-16 weeks gestational age. 1
Although 75% of meconium is water, the remaining 25% consists of gastric secretions, bile salts, mucus,
vernix, lanugo, blood, pancreatic enzymes, free fatty acids and squamous cells. Meconium staining of the
amniotic fluid (MSAF) is found in approximately 15% of pregnancies. MSAF rarely occurs before 38 weeks'
gestation. The incidence of this condition increases with longer gestations and approximately 30% of
newborns have MSAF at 42 weeks. 2
Several lines of evidence challenge the concept that aspiration of meconium is responsible for severe MAS
and suggest that other events cause the syndrome, with meconium in the lungs as an co- incidental
finding.3, 4 The passage of meconium in utero may be a response to stresses such as chronic hypoxia,
acidaemia or infection, processes that may interfere with clearing of meconium. 1
Consequences
The most severe condition associated with meconium passage in utero, the meconium aspiration
syndrome (MAS), occurs in 2 to 5% of patients with MSAF.2 At RPA Hospital from 1992-1997, 102 infants
had a diagnosis of MAS. Forty-seven (46%) were ventilated with 3 (6% of ventilated infants) dying.
Diagnosis
Usually, MAS is diagnosed on the clinical history of an infant born through meconium stained liquor, an
infant with respiratory distress and coarse opacification seen on CXR. The diagnosis is supported by
acidosis and meconium suctioned from below the cords. CXR findings are not prognostic on severity of
MAS.
Treatment
Pre-delivery prevention of MAS:
Routine induction before 41 weeks reduces perinatal mortality, but only shows a trend towards reduction of
MAS.5 Amnioinfusion for meconium stained liquor in labour can reduce the number of babies developing
MAS (RR 0.44, 95%CI 0.25-0.78), but is associated with some serious maternal side effects. The benefit of
this therapy needs to be further investigated before implementing.6
150mg/kg Survanta every 6 hours. A click test could assess the need for surfactant in MAS.
Nitric Oxide treatment improves outcome in near term babies with severe hypoxic respiratory failure
including MAS and can be started after echocardiographic confirmation of pulmonary hypertension. 15 .
16
Key Points
Key Point
Level of Evidence
References
1. Ahanya SN, Lakshmanan J, Morgan BL, Ross MG. Meconium passage in utero: mechanisms,
consequences, and management. Obstet Gynecol Surv. 2005 Jan; 60(1): 45-56
2. Wiswell TE. Handling the meconium-stained infant. Semin Neonatol. 2001 Jun; 6(3): 225-31.
3. Ghidini A, Spong CY. Severe meconium aspiration syndrome is not caused by aspiration of meconium.
Am J Obstet Gynecol. 2001 Oct; 185(4): 931-8
4. Pinar H. Postmortem findings in term neonates. Semin Neonatol. 2004 Aug; 9(4): 289-302
5. Crowley P. Interventions for preventing or improving the outcome of delivery at or beyond term.
Cochrane Database Syst Rev. 2000;(2):CD000170
6. Hofmeyr GJ. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev.
2002;(1):CD000014
7. Wiswell TE, Gannon CM, Jacob J, Goldsmith L, Szyld E, et all. Delivery room management of the
apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial.
Pediatrics. 2000 Jan; 105: 1-7
8. Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal
suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised
controlled trial. Lancet. 2004 Aug 14; 364(9434): 597-602
9. Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous,
meconium-stained infants born at term. Cochrane Database Syst Rev. 2001;(1):CD000500
10. Bhuta T, Clark RH, Henderson-Smart DJ. Rescue high frequency oscillatory ventilation vs conventional
ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst
Rev. 2001;(1):CD002974
11. van Kaam AH, Haitsma JJ, De Jaegere A, van Aalderen WM, Kok JH, Lachmann B. Open lung
ventilation improves gas exchange and attenuates secondary lung injury in a piglet model of meconium
aspiration. Crit Care Med. 2004 Feb; 32(2): 443-9
12. Evans N, Kluckow M, Currie A. Range of echocardiographic findings in term neonates with high oxygen
requirements. Arch Dis Child Fetal Neonatal Ed. 1998 Mar; 78(2): F105-11.
13. Beierholm EA, Grantham N, O'Keefe DD, Laver MB, Daggett WM. Effects of acid-bas changes, hypoxia
and catecholamines on ventricular performance. Am J Physiol. 1975; 228: 1555-1561.
14. Soll RF, Dargaville P. Surfactant for meconium aspiration syndrome in full term infants. Cochrane
Database Syst Rev. 2000;(2):CD002054
15. Finer NN, Barrington KJ. Nitric oxide for respiratory failure in infants born at or near term. Cochrane
Database Syst Rev. 2001;(4):CD000399
16. Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane
Database Syst Rev. 2003;(4):CD003485
17. Salvia-Roiges MD, Carbonell-Estrany X, Figueras-Aloy J, Rodriguez-Miguelez JM. Efficacy of three
treatment schedules in severe meconium aspiration syndrome. Acta Paediatr. 2004 Jan; 93(1): 60-5
18. Davis PG, Henderson-Smart DJ. Intravenous dexamethasone for extubation of newborn infants.
Cochrane Database Syst Rev. 2001;(4):CD000308
Last Reviewed: September 2005