Meconium aspiration syndrome Flashcards
Meconium aspiration syndrome
It is a respiratory distress In an infant 👶
Meconium aspiration syndrome (MAS) happens when a newborn has trouble breathing because meconium got into the lungs.
OR
Meconium aspiration syndrome occurs when a newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery. Meconium aspiration syndrome, a leading cause of severe illness and death in the newborn, occurs in about 5 percent to 10 percent of births.
What Is Meconium?
Meconium is a newborn’s first poop. This sticky, thick, dark green poop is made up of cells, protein, fats, and intestinal secretions, like bile. Babies typically pass meconium (mih-KOH-nee-em) in the first few hours and days after birth. But some babies pass meconium while still in the womb during late pregnancy.
Meconium can make it harder to breathe because it can:
Meconium can make it harder to breathe because it can:
clog the airways
irritate the airways and injure lung tissue
block surfactant, a fatty substance that helps open the lungs after birth
With treatment, most babies with meconium aspiration syndrome get better with no problems. True or False?
True
What Causes Meconium Aspiration Syndrome?
Meconium aspiration happens when a baby is stressed and gasps while still in the womb, or soon after delivery when taking those first breaths of air. When gasping, a baby may inhale amniotic fluid and any meconium in it.
Babies are more likely to pass meconium when:
Babies are more likely to pass meconium when:
They’ve had a long or hard delivery.
They are born past their due date.
The mother has a health problem, like diabetes or high blood pressure.
The mother smoked or used drugs during the pregnancy.
They didn’t grow well before birth
Babies who are stressed by low oxygen levels or infections also may pass meconium before birth. When meconium gets in the amniotic fluid, there’s a chance a baby will breathe (aspirate) it into the lungs before, during, or after birth. But most babies with meconium in the amniotic fluid will not get MAS.
Clinical Features/ What Are the Signs & Symptoms of Meconium Aspiration Syndrome?
Clinical Features : HISTORY Taking
Many are depressed at birth
IUGR
They often are term or post term
Infants 👶 with MAS must have a history of MSAF
Clinical Features: PHYSICAL EXAMINATION 🧐
- Evidence of post maturity
— peeling skin
— long fingernails
— decreased vernix. - The vernix, umbilical cord, and nails 💅 may be meconium stained, depending on how long the infant 👶 has been exposed to utero
- In general nails 💅 will become stained after 6 hours and vernix after 12 to 14 hours of exposure
- Umbilical cord staining ( thick 15 mins. Thin 1 hour).
- Affected patient typically have respiratory distress with marked tachypnea and cyanosis
- use of accessory muscles of respiration are evidenced by intercostal and subcostal retraction and abdominal ( paradoxical ), breathing 😮💨, often with grunting and nasal flaring
- The chest typically appears barrel shaped with an increased anterior-posterior diameter caused by overinflation
- auscultation reveals rales and rhonchi
—- immediately after birth - Some patients are asymptomatic at birth and develops worsening signs of respiratory distress as the meconium moves from the large airways into the lower tracheobronchial tree
Symptoms:
Before or at a baby’s birth, doctors will notice one or more of these signs:
The amniotic fluid is meconium-stained (green).
The baby has meconium stains.
The baby has breathing problems or a slow heart rate.
The baby is limp.
How Is Meconium Aspiration Syndrome Diagnosed?
- A chest radiograph
— shows hyperinflation of the lung 🫁 field and flatten diaphragms - There are coarse irregular patchy infiltrates
- A pneumothorax and pneumomediatenum may be present
- Arterial blood 🩸 gas measurements typically shows hypoxemia and hypercarbia
- Echocardiogram for evaluation of PPH
- Infant 👶 with pulmonary hypertension and right to left shunting may have a gradient in oxygenation between preductal and postductal samples.
Doctors diagnose MAS in any baby with breathing problems who is born through meconium-stained fluid and has no other cause for the breathing problems. A chest X-ray can confirm the diagnosis. Doctors may do other tests to be sure nothing else causes the symptoms, such as a heart problem or pneumonia.
How Is Meconium Aspiration Syndrome Treated?
Most babies with MAS get medical care in a special care nursery or neonatal intensive care unit (NICU) and get oxygen, if needed.
A baby who gets extra oxygen but still struggles to breathe will get help from a breathing machine (ventilator). An infant with severe MAS may need more treatment, such as:
surfactant to help open lungs
inhaled nitric oxide. This gas is added to oxygen to open blood vessels and improve oxygen delivery.
extracorporeal membrane oxygenation. The ECMO machine, using a pump that works like the heart, pumps blood from the body through an artificial lung. Like a normal lung, it adds oxygen to the blood and removes carbon dioxide. Then the machine sends the blood back to the child.
Most babies with MAS get better within a few days or weeks, depending on how much meconium they inhaled.
Can Meconium Aspiration Syndrome Be Prevented?
Can Meconium Aspiration Syndrome Be Prevented?
If a woman goes past her due date, her doctor may recommend inducing labor to help prevent MAS. If a pregnant woman’s water breaks and she sees dark green stains or streaks in the fluid, she should tell her doctor right away. This is a sign that meconium is in the amniotic fluid.
In the past, doctors sometimes did amnioinfusion (using saline to dilute meconium in the amniotic fluid) or suctioned meconium out of the baby’s mouth and throat at birth. But these treatments weren’t found to prevent MAS, so are not routinely done.
Most infants with meconium aspiration syndrome recover completely. Some babies may have a higher risk of lung infections and wheezing, particularly in their first year of life.
True
Composition of meconium
Epithelial cells
Fetal hair
Mucus
Bile
Risk factors of MAS
Maternal hypertension
Maternal Diabetes Mellitus
Smoking 🚬
Maternal respiratory or cardiovascular 🫀 disease 🦠
Post term pregnancy 🤰
Pre eclampsia/ eclampsia
Oligohydramnios
IUGR
Abnormal fetal heart rate pattern
Vernix
Vernix caseosa is a white, creamy, naturally occurring biofilm covering the skin of the fetus during the last trimester of pregnancy. Vernix coating on the neonatal skin protects the newborn skin and facilitates extra-uterine adaptation of skin in the first postnatal week if not washed away after birth.
Differential diagnosis
Perinatal asphyxia
Bacteria 🦠 pneumonia
Respiratory distress syndrome
Congenital heart🫀 disease 🦠
Transient tachypnea of newborn 👶
