Mecocium Aspiration Syndrome

MECONIUM ASPIRATION
SYNDROME
Written by: Dr. Prithwiraj Maiti, R.G.Kar Medical College
Resources used: Nelson’s Pediatrics, Rudolph’s Pediatrics, CMDT
of Pediatrics and IAP Textbook of Pediatrics
INTRODUCTION
• Meconium aspiration syndrome (MAS) is one of the most common
causes of severe respiratory failure in infants born at term/ post-term
gestation.
• Meconium is the first stool of an infant, composed of materials ingested

during the period of gestation.
• Meconium is normally stored in the infant's intestines until after birth,

but sometimes (often in response to fetal distress and hypoxia) it is
expelled into the amniotic fluid prior to birth, or during labor. If the
baby then inhales the meconium, MAS may occur.
 Aspiration of meconium can occur in utero, during birth or
immediately after birth.
 Thin meconium can cause pneumonitis,
 Thick meconium aspiration can block large & small airways causing
atelectasis & emphysema.
Definition:
Meconium Aspiration Syndrome (MAS, alternatively "Neonatal aspiration of meconium") is a
medical condition affecting newborn. It occurs when meconium is present in their lungs during or
before delivery. Meconium is the first stool of an infant, composed of materials ingested during the
time the infant spends in the uterus.
Aspiration of amniotic fluid containing meconium into foetal or new born trachea in utero for a
first breath. ( Wong)
The condition is by and large limited to term babies and characterized by respiratory distress with
air trapping due to valve effect of meconium. The resistance to airflow is markedly increased
while compliance is normal or minimally decreased.
( Meharban Singh)
Incidence:
Meconium passage into the amniotic fluid occurs in about 5-20 percent of all births
and is more common in overdue births.
Causes
Foetal distress during labour causes intestinal contractions, as well as relaxation of
the anal sphincter, which allows meconium to pass into the amniotic fluid and
contaminate the amniotic fluid.
Advance gestational age (greater than 40 weeks)
 Difficult delivery
 Fatal distress
 Intrauterine hypoxia
 Maternal diabetes
 Maternal hypertension
 Poor intrauterine growth
The cases where meconium is found in the amniotic fluid, meconium aspiration
syndrome develops less than 5% of the time.
Amniotic fluid is normally clear, but becomes greenish if it is tinted with meconium.
MECHANISM OF MECONIUM ASPIRATION
The foetus normally swallows the amniotic fluid. Although the foetus exhibits
breathing like movements in utero, the fluid does not enter the trachea except during
episodes of severe hypoxia. In majority of cases meconium passed during labour and
delivery may be initially swallowed into the orophrynx and subsequently aspirated into
trachea-bronchial tree with the first breaths only.
RISK FACTORS
Maternal risk factors includes all which induce fetal distress and
hypoxia:
1. Preeclampsia,
2. Hypertension,
3. Oligohydramnios,
4. Maternal infections,
5. Maternal drug use,
6. Placental insufficiency,
7. Intrauterine growth restriction.
PATHOPHYSIO
LOGY
SIGNS AND SYMPTOMS:
1. Meconium stained skin, nails and umbilical cord

2. Signs of respiratory distress develop usually within the 1st hour of
birth:
A. Tachypnoea,
B. Intercostal retractions,
C. Coarse bronchial sounds,
D. Expiratory grunting, and/or
E. Cyanosis.
3. Chest may be overinflated/ barrel shaped, with a protruding
sternum (due to obstructive emphysema).
DIAGNOSTIC TEST
• Physical examination
• Chest x ray
• ABG in first hour of birth: Often reveals evidences of perinatal
asphyxia-
1. Hypoxemia and
2. Some degree of metabolic acidosis.

MANAGEMEN
T
• Treatment of MAS includes supportive care and standard management
for respiratory distress
• Endotracheal intubation and suction to remove meconium from the
airway
before the 1st breath in the delivery room is essential
• In infants with clinical signs of respiratory failure; oxygen saturation by

pulse oximetry, ABG and a CXR should be obtained as soon as possible
• In infants with MAS who develop complications (like pneumothorax)

PROGNOSIS
 With ventilatory support 60-70% neonates survive but in absence of
ventilatory support mortality is high in severe cases.

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MECONIUM ASPIRATION

• Meconium is the first stool of an infant, composed of materials ingested

• Meconium is normally stored in the infant's intestines until after birth,

1. Meconium stained skin, nails and umbilical cord

2. Some degree of metabolic acidosis.

• In infants with clinical signs of respiratory failure; oxygen saturation by

• In infants with MAS who develop complications (like pneumothorax)

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