| ID | 365 |
|---|---|
| Name | MECONEUM ASPIRATION PNEUMONIA (MECONEUM ASPIRATION SYNDROME) |
| Cause | When a baby is stressed and gasps while still in the womb, or soon after delivery when taking those first breaths of air |
| Signs Symptoms | Rapid or labored breathing. Retractions, or pulling in of the chest wall. Grunting sounds with breathing. Bluish skin color, called cyanosis. Low apgar score, a rating of a baby's color, heartbeat, reflexes, muscle tone and respiration just after birth. Limp body. |
| Diagnosis | A chest X-ray can confirm the diagnosis |
| Investigations | A chest X-ray can confirm the diagnosis |
| Management | Management: A. Immediate resuscitation- 1. Atraumatic removal of oropharyngeal & tracheal aspirate or meconeum immediately after birth in delivery room. 2. Endotracheal intubation & suctions are indicated when there is meconeum staining. 3. Stomach wash- with normal saline by introducing N.G tube if indicated. 4. Supportive care for resp. distress- with incre-ased ventilation &/or O2 inhalations. B. Antibiotic therapy & other managements: Same as for congenital or neonatal pneumonia. |
| Introduction | In about 10-15% of term or post-term births meconium-stained amniotic fluid is found. Among these infants about 5% develop meconeum aspiration pneumonia; 30% of them require mechanical ventilation and 3-5% of the rest expire. During prolonged or difficult labour foetus often initiate vigorous respiratory movements in utero because of interference with the supply of O2 via the placenta. There has been foetal distress, hypoxia & passage of meconeum into the amniotic fluid. These infants are often meconeum-stained and depressed. Under such circumstances the foetus usually aspirates amniotic fluid containing meconeum either in uterus or more often with the first breath. Thick meconenun is aspirated into the lungs, which often blocks the smallest airways & interferes with the alveolar exchange, this airway obstruction usually leads to- - respiratory distress within the first hour - tachypnoea - grunting & - cyanosis in severely affected infants. Prompt resuscitation & treatment may delay the onset of respiratory distress, which may consist of only tachypnoea without retractions. Over distention of the chest may be prominent. But, when its course requires assisted ventillation, it may be severe & its potential for mortality is high. X-ray may show - - Patchy infiltrates. - Coarse streaking of both lung fields. - Increased antero-posterior diameter - Flattening of diaphragm. - Arteriol PO2 - may be low. Acidosis (metabolic)- if hypoxia occur. |
| History | |
| Etiology | see under cause |
| Clinical Features | see under sign and symptoms |
| Preventions | Appropriate suctioning at birth. |
| Treatment | Antibiotics to treat infection. Breathing machine to keep the lungs inflated. Use of a warmer to maintain body temperature. Tapping on the chest to loosen secretions. |
| Complications | |
| Prognosis | Prognosis: The mortality of meconeum stained infants are higher than non-stained; and meconeum aspiration accounts for a significant proportion of neonatal death. Residual lung problems are rare. But problems may complicate the condition. |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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