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MECONIUM ASPIRATION SYNDROME
INTRODUCTION � Meconium aspiration syndrome is one of the most common cause of respiratory distress in term and post term infants. MAS occurs in about 10% of infants born through meconium stained amniotic fluid. Infants born through meconium stained amniotic fluid are 100 times more likely to develop respiratory distress compared to infants born through clear amniotic fluid.
DEFINITION � Meconium aspiration syndrome is defined as the condition in which the newborn inhales meconium mixed with amniotic fluid either in utero or just after delivery
CAUSE � MAS results from fetal distress
PATHOPHYSIOLOGY � � � MAS results in 1) Airway obstruction 2)Chemical pneumonitis 3)Surfactant dysfunction Meconium aspiration Airway obstruction Decreased levels Increased irritation Of surfactant proteins &Toxicity Decreased surface tension Parenchymal inflammation Pneumonitis
SIGNS AND SYMPTOMS Bradycardia � Dark greenish staining of amniotic fluid � Yellow staining of skin , cord and nails � Infants may appear limp at birth � Cyanosis � Tachypnoea � Laboured breathing � Apnoea � Streaking in x-ray �
INVESTIGATIONS � Blood gas analysis � Blood culture � X-ray chest
MANAGEMENT � � � � � After birth Thorough oropharyngeal suctioning If no severe risk , keep under warmer. Oxygen and observe for vital signs. If depresssed baby , intubation tobe initiated. PPV should be avoided. Do thorough laryngotracheal toileting. Thorough stomach wash with Normal saline. Nurse the baby in a thermoneutral environment with oxygen. Restricted IV Fluids to prevent pulmonary oedema. Prophylactic antibiotics after taking blood culture sample. Assisted ventilation tobe provided if respiratory failure occurs. Chest drainage if pneumothorax occurs.
MANAGEMENT � The labour complicated with MSAF should be closely monitored and baby should be delivered without delay by an emergency cesarean section or assisted vaginal delivery depending upon the status of the cervix and stage of labour. � Be ready to resuscitate the baby
COMPLICATIONS � Aspiration pneumonia � Pneumothorax � Persistant respiratory distress � Seizures � Cerebral palsy � Mental retardation
PROGNOSIS � The out come depends upon the degree of brain damage. Respiratory distress subsides within 2 to 4 days , although rapid breathing may persist for days. Infants with severe aspiration that require mechanical ventilation have a more guarded outcome