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MECONIUM ASPIRATION SYNDROME
Meconium aspiration syndrome may be defined as meconium below the vocal cords. Meconium aspiration has been reported to occur in the range of 7-58% (mean of 32.5%) of meconium stained live births. ... Most neonates who aspirate meconium will have evidence of oropharyngeal meconium at delivery.
Throughout the 1970’s and 1980’s most investigators attributed meconium aspiration to fetal breathing and gasping during and immediately after delivery. ... Many investigators now believe that a significant percent of meconium aspiration occurs in utero. One such investigator demonstrated the presence of meconium in the lungs of fetuses that died in utero secondary to asphyxia. Several studies document meconium aspiration despite oropharyngeal suctioning before the first breath is taken.
Neonates born through meconium stained amniotic fluid, who subsequently develop respiratory complications attributed to meconium, are believed to have MAS, meconium aspiration syndrome. The incidence of MAS appears to be approximately 2% of meconium stained babies or about . ... Hypoxia may result from mechanical obstruction, pneumonitis, and secondary atelectasis by meconium. ... Traditionally the pathophysiologic changes that comprise MAS have been attributed to the direct effects of meconium on the pulmonary system. ... Many investigators site the following observations that downplay the role of meconium as the primary cause of MAS:
1. Approximately 33% of neonates born through meconium will have meconium below the vocal cords, yet <10% of these neonates will develop respiratory distress. ... Clinical disease may develop without histologic evidence of meconium aspiration. ... Clinical disease may develop without meconium being found below the vocal cords. ... Some infants die in utero or within one hour of delivery with histologic evidence of meconium aspiration. ...
The question now becomes, what is the exact relationship between meconium aspiration and MAS? Does the presence of meconium cause pulmonary disease of does it exacerbate pre-existing pulmonary disease that may result during hypoxia? Although it has been demonstrated that meconium aspiration without asphyxia led to minimal respiratory complications in greater than 90% of neonates, there is evidence that meconium is able to cause considerable pulmonary damage. The inflammatory response to meconium may give rise to consolidation and pneumonia with edema. Vasoactive substances in meconium may directly constrict pulmonary vessels with resultant pulmonary hypertension.
Approximate Word count = 1780
Approximate Pages = 7.1
(250 words per page double spaced)
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