Meconium aspiration syndrome
Aspiration of meconium-stained liquor (term/post-term; fetal distress)
Overview
Respiratory distress in a TERM/POST-TERM infant who has passed and aspirated MECONIUM (a sign of fetal distress/hypoxia) before/during birth. Meconium obstructs and inflames the airways and inactivates surfactant, causing distress, air-trapping and persistent pulmonary hypertension. CXR shows patchy infiltrates/hyperinflation. Supportive intensive care; risk of pneumothorax and PPHN.
Recognise
- TERM/post-term infant with meconium-stained liquor and respiratory distress from birth (tachypnoea, recession, cyanosis)
- CXR: patchy/streaky infiltrates with hyperinflation; risk of pneumothorax
- Complications: persistent pulmonary hypertension of the newborn (PPHN), air leaks
Red flags
- Persistent pulmonary hypertension (severe hypoxia, pre/post-ductal saturation difference) → intensive care (± nitric oxide)
- Pneumothorax (sudden deterioration)
Differentials & how to tell them apart
Investigations
Clinical (meconium-stained liquor + distress) + CXR (patchy infiltrates, hyperinflation); blood gas; echo if PPHN suspected.
Management
Supportive intensive care (± surfactant/antibiotics; nitric oxide for PPHN)
- 1Supportive intensive care: respiratory support/ventilation, oxygen, treat as/exclude sepsis; manage air leaks.Gate: Watch for and treat PERSISTENT PULMONARY HYPERTENSION (severe hypoxia, pre/post-ductal saturation gradient) — may need inhaled nitric oxide; routine intrapartum suctioning of vigorous babies is NOT recommended
- 2Intensive support; nitric oxide/ECMO for severe PPHN; manage complications (pneumothorax).
Key points
Post-term + meconium-stained liquor + respiratory distress + patchy CXR = meconium aspiration → supportive care; watch for PPHN and pneumothorax. A marker of fetal distress.
Monitor & prognosis
Oxygenation, pre/post-ductal saturations (PPHN), air leaks.
Variable; severe PPHN is dangerous.
Source: RCPCH; NLS