MECONIUM ASPIRATION SYNDROME

Problems
Usually a history of post-term delivery and a history of
fetal distress
May occur in preterm associated with IUGR
Meconium- stained liquor with meconium in the mouth
and pharynx and also in the skin, nail, umbilicus
Tachypnea, recession, often grunting with or without
cyanosis or apnea from birth
Barrel-shaped chest (anterior and posterior diameter
shown in Fig. 95).

Diagnosis
Meconium Aspiration Syndrome (MAS)
The presence of meconium in the amniotic fluid is a warning
sign of fetal distress. This may be aspirated by the fetus in the
uterus prior to delivery or by the newborn during labor and
delivery. Aspiration of thick meconium by the baby can cause Fig. 95: Infant with MAS (under mechanical ventilation) showing
airway obstruction. hyperinflated chest ( anterior posterior diameter)
Large airway obstruction causeshypoxia, small airway Investigations for Diagnosis and Management of
obstruction causes atelectasis, ball and valve mechanism causes
the Patient
hyperinflation and pneumothorax. Meconium aspiration
causes chemical pneumonitisleads to surfactant production Radiological diagnosis: by chest X-ray (Fig. 96)
inhibition and persistent pulmonary hypertension. If the Hyperinflation of lungs field
meconium is thick give suction of the mouth immediately after Low flat diaphragm
delivery of head but before the shoulder is delivered. Patchy opacity
Pneumothorax and pneumomediastinum.
Assessment of the Baby with MAS Clinical diagnosis and assessment:
Immediate Assessment of Vitals Signs Direct laryngoscopy- Shows that meconium is present
Respiration, heart rate, temperature, including color, perfusion, in the oropharynx.
oxygen saturation, muscle tone. Complete blood count (CBC)- for septic screening.
Other investigations- for management purposes:
General Physical Assessment Blood gas-Respiratory acidosis- Hypoxia, increased
PCO2 decreased pH
The baby may present with dyspnea, tachypnea, subcostal and
Echo-Color Doppler- May show:
intercostal recession, nasal flaring, expiratory grunting with or
- Intra-atrial shunt
without cyanosis and apnea. Meconium staining present in the
- PDA may be found
skin, nails, umbilicus and even all over the body.
Cranial USG: To exclude asphyxial encephalopathy
Systemic Assessment Blood sugar and serum calcium- To exclude hypo-
glycemia, hypocalcemia.
Respiratory rate:
Respiratory system: RR- may be >60/min.
Anterior posterior diameter of the chest is increased
(Barrel-shaped chest)
Poor air entry
Bilateral coarse crepitation and rhonchi may be
present.
CNS: Some of these babies will have associated asphyxial
encephalopathy- so neurological status should be assessed.
Musculoskeletal system: Some of these babies may present
with poor muscle tone and present as flaccid baby.
Evaluation of history and overall condition-
Commonly seen in post-term baby (30%), term with
IUGR.
There may be history of fetal distress, perinatal asphyxia, Fig. 96: X-ray chest of MAS showing hyperinflation with low flat
meconium-stained amniotic fluid. diaphragm, nodular opacity and air leaks
Treatment of MAS Complications of MAS
As the baby presented with respiratory distressresuscitate Chemical pneumonitis
the baby first at the same time with ABC management. Rapid Pneumothorax
assessment of the vitals signsRespiration, heart rate, Air leak syndrome
temperature, color, O2-saturation, capillary refilling time and Respiratory failure
blood is sent for blood gas analysis (if facility is available). Persistent pulmonary hypertension of the newborn
Antenatal management: (PPHN)
Identification of high risk pregnancies. Intracardiac shunt
Institutional delivery Chronic lung disease
Follow-upclinical and by USGfor assessment of Bronchopulmonary dysplasia.
condition of the baby
Biophysical profile and delivery as early as possible. Prognosis
Postnatal management: Death rate: 5% with all support available.
Suction: Proper and adequate suction- First orally
and then nasally. If thick meconium and direct
laryngoscopy shows that meconium is present in the
oropharynx at birth, the baby should be intubated
immediately and meconium should be aspirated from
the larynx and trachea.
Oxygen inhalation
Cleaning of the baby
Maintenance of temperature
Maintenance of nutritionIV 10%/ dextrose- 2/3rd of
the daily requirement

Antibiotics- Inj. Ampicillin + Inj. Gentamycin

(Meconium aspiration increases the risk of secondary
bacterial infection)
If cyanosis, respiratory distress, gasping and flat baby-
shifted to NICU.
In NICU- oxygen inhalation- by Hood box

Arterial blood gas

If ABG shows
Hypoxia, hypercarbia and impending respiratory failure- Then

Arrange for mechanical ventilation- with high PIP pressure

and ventilatory rate and shortening of inspiratory time and
prolong expiratory time (increased Ti/Te ratio) which relieves
cyanosis and remove CO2.
An ideal ventilatory setting for MAS as follows: PIP 2126
cm of H2O, Ventilatory rate- 5060/min, Ti/Te ratio 1:4 (See
Ventilatory setting in RDS chapter).
Treatment of complication- accordingly if any.