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Meconium aspiration syndrome

**{{{Name|Meconium aspiration syndrome}}}**
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ICD-10	{{ICD10
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 ICD9           = 770.11, 770.12|
 ICDO           = |
 OMIM           = |
 MedlinePlus    = 001596 |
 eMedicineSubj  = ped |
 eMedicineTopic = 768 |
 DiseasesDB     = 7907 |

}} Meconium aspiration syndrome (MAS, alternatively "Neonatal aspiration of meconium") occurs when infants take meconiuminto their lungs during or before delivery. Meconium is the first stoolof an infant, composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, aminotic fluid, bile, and water. Meconium is sterile, unlike later feces, and has no odor.

Meconium is normally stored in the infant's intestines until after birth, but sometimes (often in response to fetal distress) it is expelled into the amniotic fluid prior to birth, or during labor. If the baby then inhales the contaminated fluid, respiratory problems may occur.

Inhaltsverzeichnis

1 Causes and risk factors
2 Symptoms and signs
3 Treatment
4 Prevention
5 See also

Causes and risk factors

Meconium passage into the amniotic fluid occurs in about five to twenty percent of all births. This is commoner in postdate births. Meconium aspiration syndrome develops in only 5-10 percent of these cases. Frequently, fetal distressduring labor causes intestinal contractions, as well as a relaxation of the anal sphincter, which allows meconium to contaminate the amniotic fluid. Amniotic fluid is normally clear, but becomes greenish if it is tinted with meconium. If the infant inhales this mixture before, during, or after birth, it may be sucked deep into the lungs. Three main problems occur if this happens:

the material may block the airways
efficiency of gas exchange in the lungs is lowered
the meconium-tainted fluid is irritating, inflaming airways and possibly leading to chemical pneumonia

About a third of those infants who experience MAS require breathing assistance.

Symptoms and signs

The most obvious sign that meconium may have been aspirated is the greenish appearance of the amniotic fluid. The infant's skin may be stained green if the meconium was passed a considerable amount of time before birth. Rapid or labored breathing, slow heartbeat, or low Apgarscore are all signs of the syndrome. Inhalation can be confirmed by one or more tests such as using a stethoscopeto listen for abnormal lung sounds, performing blood gas tests, and using chest X-rays to look for patchy or streaked areas on the lungs. When meconium staining of the amniotic fluid is present and the baby is born depressed, a pediatrician will often use a laryngoscopeand attempt to suction meconium from below the vocal cords.

Treatment

One of the most common methods for minimizing MAS is the suctioning of the throat and nose, performed by the obstetrician as soon as the head is delivered. As per the recent American Academy of Pediatrics guidelines, deeper suctioning of the trachea may be called for if the baby appears depressed. Infants who have inhaled meconium develop respiratory distress--often requiring ventilatory support. Complications of MAS include pneumothoraxand persistent pulmonary hypertension of the newborn.

Prevention

MAS is difficult to prevent. Ensuring that the infant is born before 42 weeks of gestation may lessen the risk. Amnioinfusion is a method of thinning thick meconium that has passed into the amniotic fluid. In this procedure, a tube is inserted into the uterus through the vagina, and sterile fluid is pumped in to dilute thick meconium.