meconium aspiration syndrome
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
RT 256
Meconium Aspiration Syndrome
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 newbornThick and sticky, highly viscousGreen to black in color
Aspiration of Meconium
1.Physical presence in the airways
2.Chemical pneumonitis3.Hypoxia induced
pulmonary arterial vasoconstriction and vasospasm
Physical presence in the airways leads to:
• Upper airway obstruction
• Migration past glottis
• Penetration into smaller airways
• Ball-valve effect – alveolar rupture
Chemical Pneumonitis
Acute inflammatory reaction EdemaExcessive bronchial
secretionsAlveolar consolidationPromotes the growth of
bacteriaDecreases pulmonary
surfactant production
Hypoxemia
Hypoxia induced pulmonary arterial vasoconstriction and vasospasm
Shunts blood right to left through the ductous arterious and foramen ovale
Intrapulmonary shuntingPulmonary hypoperfusion
Etiology
10% of birthsHigh 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
1. A PHYSIOLOGIC MATURATION EVENT
2. RESPONSE TO ACUTE HYPOXIC EVENTS OCCURRING LATE IN PREGNANCY
3. RESPONSE TO CHRONIC INTRAUTERINE HYPOXIA
Meconium passage
Presentation
Amniotic fluid examined Meconium staining of skin, nails, umbilical
cordManifestations of Respiratory Distress:
Barrel chest Breath sounds – rhonchi, crackles, wheezing Retractions Cyanosis Increased respiratory rate Increased heart rate
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 TherapySupport ventilation as requiredMedications