Niyaha Abdulrahim

Witney Grace Agad

Trexie Alimpoos
Aliah Ali

MECONIUM
ASPIRATION

Mindanao State University – College of Medicine

Department of Internal Medicine
MECONIUM
• first intestinal discharge of the newborn infant
• sterile, thick, black-green, odorless material
• contains epithelial cells, desquamated skin, fetal hair, mucus,
fatty acids, bile, water, proinflammatory components and
even drug metabolites
MECONIUM ASPIRATION
• aspiration of meconium-stained amniotic fluid in utero
• caused by acute or chronic hypoxia and/or infection in utero
• cause airway obstruction, interfere gas exchange, air
trapping and inflammatory response
• MAS Hallmark: poor lung compliance, hypoxemia and
characteristic lung radiograph
INCIDENCE
• varies from 8-20% of all deliveries
• only 5% develop to MAS and >50% requires mechanical
ventilatory support
• very low among pre-terms (absence of enzyme-MOTILIN)
RISK FACTORS FOR MSAF
• Age of gestation (esp. postmaturity)- highest in those
AOG >41 weeks
• SGA
• Placental Insufficiency
• Fetal Distress
• Cord compression
• Low 5 minute APGAR Score
PATHOPHYSIOLOGY
HORMONAL STIMULATION
PARASYMPATHETIC NEURAL MATURATION

Factors: Fetal Distress and Vagal Stimulation

 Cause:
1. Bronchiolar Edema
2. Narrowing of Small Airways
PATHOPHYSIOLOGY
END RESULT:
1. Respiratory Failure
2. Persistent Pulmonary
Hypertension
MSAF
CLINICAL MANIFESTATIONS
Features of Infants
1. Often there are signs of postmaturity
2. Respiratory distress evident at birth or in transition period
a. Significant perinatal asphyxia may cause:
• respiratory depression with poor respiratory effort
• decreased muscle tone
b. Presenting Manifestation
• High respiratory rate ranging from 60-100 cpm
• Cyanosis, retractions, grunting, nasal flaring, inc. AP diameter of chest
• Rales, ronchi or wheezing
MSAF
CLINICAL MANIFESTATIONS
Features of Infants
3. Meconium staining-proportional to length of exposure and
meconium concentration
• Umbilical cord staining – 15mins exposure to thick MSAF or 1hr to lightly
stained fluid
• Yellowing staining of nails – 4-6hrs of exposure
• Staining of vernix caseosa - ~12hrs
MSAF
CLINICAL MANIFESTATIONS
General Features of Amniotic Fluid
1. Appearance and Viscosity
• green-stained fluid to thick “pea soup” consistency
DIFFERENTIAL DIAGNOSIS
1.Transient Tachypnea of the Newborn
2.Neonatal Pneumonia
3.Congenital Heart Disease
4.CNS Insult
5.Respiratory Distress Syndrome
DIAGNOSIS
Laboratory Studies
1. Arterial Blood Gas
• Hypoxemia
• Respiratory alkalosis secondary to hyperventilation
• Respiratory acidosis secondary to airway obstruction,
atelectasis, pneumonitis
• Metabolic acidosis secondary to perinatal asphyxia
DIAGNOSIS
Imaging Studies
2. Chest Radiograph
• Hyperinflation of lung fields
• Flattened diaphragms
• Widened intercostal space
• Coarse, irregular patchy
infiltrates
• Central peri-hilar streaking
DIAGNOSIS
Cardiac Echocardiogram
1. Pulmonary Hypertension
2. Right to Left Atrial and Ductal Shunt
CBC and Blood Culture
Rule out and identify the cause of infection
MANAGEMENT
1. Prenatal Management
a. Identification of High-Risk Pregnancies
SAG, AOG, Hx of MSAF and Prolonged Labor
b. Monitoring during labor
Any signs of fetal distress
c. Amnioinfusion
With moderate or thick MSAF
MANAGEMENT
2. Delivery Room Management
a. Vigorous
Signs: spontaneous respirations, HR: >100 beats/min,
spontaneous movement and extremities on flexion
Management: Routine Care only should be provided
regardless of meconium consistency
 suctioning
Initial steps in resuscitation: drying, warming, positioning
MANAGEMENT
2. Delivery Room Management
a. Depressed or Non-Vigorous
Signs: HR: <100bpm, airway obstruction (cyanotic and
gasping)
Management: intubated as quickly as feasible with
endotracheal tube connected to meconium trap aspirator
attached to wall suction at 100 mmHg.
CPAP or mechanical ventilation may be applied
MANAGEMENT
2. Management of newborn with meconium aspiration
a. General Management
Maintain a neutral thermal environment
Minimal handling protocol
Minimal adequate blood pressure and perfusion
Correct any metabolic abnormalities
Sedation
Gavage Feeding or Parenteral Nutrition
MANAGEMENT
2. Management of newborn with meconium aspiration
a. Respiratory Management
Pulmonary Toilet
Arterial Blood Gas Assessment
Oxygen Monitoring
Chest Radiograph
Antibiotic Coverage –Broad Spectrum
Mechanical Ventilation
Surfactant
Inhaled Nitric Oxide or Sildenafil
PROGNOSIS
• Complications are common and associated with
significant mortality
1. Meconium Aspiration Syndrome (due to hypoxia)
Global developmental delay
Cerebral palsy
Autism
Persistent Pulmonary Hypertension (15-30% mortality)
Pneumothorax and Pneumomediastinum
PROGNOSIS
• Complications are common and associated with
significant mortality
2. Prolonged Mechanical Ventilation
Bronchopulmonary dysplasia
Chronic lung disease

Warrants Long-term Follow-up