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Meconium Aspiration Syndrome

Meconium Aspiration Syndrome. RT 256. Meconium. Material that collects in the intestine of the fetus Intestinal tract secretions Amniotic fluid Pulmonary fetal fluid Intrauterine debris Forms the first stools of the newborn Thick and sticky, highly viscous Green to black in color.

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Meconium Aspiration Syndrome

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  1. Meconium Aspiration Syndrome RT 256

  2. Meconium • Material that collects in the intestine of the fetus • Intestinal tract secretions • Amniotic fluid • Pulmonary fetal fluid • Intrauterine debris • Forms the first stools of the newborn • Thick and sticky, highly viscous • Green to black in color

  3. Aspiration of Meconium Physical presence in the airways Chemical pneumonitis Hypoxia induced pulmonary arterial vasoconstriction and vasospasm

  4. Physical presence in the airways leads to: Upper airway obstruction Migration past glottis Penetration into smaller airways Ball-valve effect – alveolar rupture

  5. Acute inflammatory reaction • Edema • Excessive bronchial secretions • Alveolar consolidation • Promotes the growth of bacteria • Decreases pulmonary surfactant production Chemical Pneumonitis

  6. Hypoxia induced pulmonary arterial vasoconstriction and vasospasm • Shunts blood right to left through the ductousarterious and foramen ovale • Intrapulmonary shunting • Pulmonary hypoperfusion Hypoxemia

  7. Etiology • 10% of births • High risk for MAS include • Post-term • Small for gestational age • Breech presentation • Mother with toxemia, hypertension, or obesity • Cause of meconium passage, consistency, and timing

  8. Meconium passage A physiologic maturation event Response to acute hypoxic events occurring late in pregnancy Response to chronic intrauterine hypoxia

  9. Presentation • Amniotic fluid examined • Meconium staining of skin, nails, umbilical cord • Manifestations of Respiratory Distress: • Barrel chest • Breath sounds – rhonchi, crackles, wheezing • Retractions • Cyanosis • Increased respiratory rate • Increased heart rate

  10. Management • PREVENTION! • Suctioning during delivery (not current NRP guideline) • Current NRP guidelines for meconium: • Vigorous vs Not Vigorous • Strong respiratory efforts • Good muscle tone • Heart rate >100beats/min • Intubate and suction with ETT • Do NOT ventilate until all meconium is cleared • Oxygen Therapy • Support ventilation as required • Medications

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