MECONIUM ASPIRATION SYNDROME

• Meconium aspiration syndrome occurs when infants take meconium into their lungs during or before delivery

Incidence

• Incidence 10-15%; Usually in term or post term and small for date babies

Clinical Feature

• Meconium stooling is seen in 90 percent of newborns within the first 24 hours, and most of the rest within 36 hours.
• Patient with leakage of fluid and meconium stained liquor at 34 weeks of gestation is suffering from preterm premature rupture of membrane (PROM)
• Either in utero or with the first breath, thick, particulate meconium is aspirated into the lungs
• These babies usually develop respiratory distress in the first few hours of life
• Meconium is excreted by a new born till 3 day
• Saffron coloured meconium is seen in post maturity.

Content

• Meconium contains –

1. Intestinal epithelial cells  
2. Mucus 
3. Bile
4. Lanugo 
5. Amniotic fluid  
6. Water

Diagnosis

• Meconium stained liquor (amniotic fluid) with respiratory distress soon after birth suggests the diagnosis of meconium aspiration syndrome
• Chest X-ray: bilateral heterogeneous opacities (patchy infiltrates), coarse streaking of both lung fields, areas of hyper expansion, atelectasis and air leak, increased AP diameter, flattening of diaphragm

Complication

• Complications:  Persistent pulmonary hypertension
• Obstructive emphysema can occur as a result of passage of meconium in utero.
• Air leak: pneumomediastinum, pneumothorax, cystic lung disease, obstructive emphysema    
• Pulmonary hemorrhage
• Complications of asphyxia:-  encephalopathy, seizures, oliguria, coagulopathy and thrombocytopenia  pneumothorax, air leak syndromes (pneumo-pericardium, pneumo-mediastinum)

 Management

• Management: IV fluids, ventilator support,oxygen,Antibiotics