This document provides information about meconium aspiration syndrome for nursing students. It defines meconium aspiration syndrome as the aspiration of meconium-stained amniotic fluid into the lungs, occurring in 5-20% of births. The document outlines risk factors, pathophysiology involving ball valve obstruction and pulmonary hypertension, clinical features such as respiratory distress, diagnostic tests including chest x-rays, and management involving suction, oxygen, ventilation support, and medications. It also discusses nursing considerations, prognosis depending on associated conditions, and complications including brain and lung damage.
A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
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A Tracheoesophageal fistula is a congenital disease. It is a acquired communication between the trachea and esophagus. Most of the patient with TEF are diagnosed immediately following after birth.TEF are often associated with life threatening complications.
Hypothermia occurs when the newborn’s temperature drops below 36.3°C.
The smaller or more premature the newborn is, the greater the risk of heat loss. When heat loss exceeds the newborn’s ability to produce heat, its body temperature drops below the normal range and the newborn becomes hypothermic.
Early prevention measures are vital.
Surfactant replacement therapy : RDS & beyondDr-Hasen Mia
This presentation is about Surfactant, its use in Respiratory Distress Syndrome & some other conditions of surfactant deficiency due to inactivation like meconium aspiration syndrome & others
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
neonatal hypothermia is a very emergency condition. if we identify this in early stage we can save the life of neonate. all should know about the maintaining the temperature if the neonate is in our home.
Thermal care is central to reducing morbidity and mortality in newborns. Thermoregulation is the ability to balance heat production and heat loss in order to maintain body temperature within a certain normal range. The average “normal” axillary temperature is considered to be 37°C
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Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
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2. General Objective
At the end of this session, all the B.Sc.
Nursing 3rd year students will be able to
explain about meconium aspiration
syndrome in neonate.
3. Specific Objectives
At the end of this session, all the B.Sc. Nursing
3rd year students will be able to:
• define meconium aspiration syndrome.
• State the prevalence of meconium aspiration
syndrome.
• State the risk factors for meconium passage.
• describe the pathophysiology of meconium
aspiration syndrome.
4. …contd
• list out the clinical features of meconium
aspiration syndrome.
• identify diagnostic measures of meconium
aspiration syndrome.
• describe the management of meconium
aspiration syndrome.
• discuss the prognosis of meconium aspiration
syndrome.
• list out the complications of meconium
aspiration syndrome.
5. Meconium Aspiration Syndrome
• Meconium aspiration syndrome refers to a
serious condition of aspiration of meconium
stained liquor into lungs that occurs when a
fetus has been suspected to fetal asphyxia or
other intrauterine stress that causes relaxing
of the anal sphincter and passage of
meconium into the amniotic fluid.
• Meconium aspiration syndrome occurs in an
about of 5-20% of all births and more
common in postdated births.
13. ….contd
• Develop signs of respiratory distress within
first hours of life.
• They may be initially cyanotic ( circumoral
cyanosis) or pale as well as tachypneic
and they may demonstrate the barrel
shaped chest.
18. Diagnosis
• Inspection : Meconium stained liquor, baby
appears to be stained green from
meconium, meconium can often be
visualized by laryngoscopy in the
respiratory passage and vocal cord.
• Assessment and evaluation of clinical
manifestations.
• On auscultation for lung sounds, coarse
crackles are heard.
19. ....contd
• Blood gas analysis shows low blood pH .
• Chest radiograph shows uneven
distribution of patchy infiltrates, air
trapping, hyper expansion and atelectasis.
• Echocardiography shows the diagnosis of
right to left shunt.
21. Management
A. Immediate Management
If baby is vigorous
• Don't electively intubate.
• Clear suction and meconium from mouth
and nose with a bulb syringe or a large
bore suction catheter.
22. …contd
If baby is not vigorous
• Suction trachea immediately after delivery.
• If meconium is not retrieved, don’t repeat
intubation and suction.
• If meconium is retrieved and no brady is
present, intubate and suction.
• If heart rate is low, administer positive
pressure ventilation and consider
suctioning again later.
23. ….contd
• Dry, stimulate and administer oxygen as
necessary.
• Transfer ill newborn with respiratory
distress to NICU.
24. B. General Management
• Most babies born through meconium
stained liquor do not require any
resuscitation at birth and remain well.
• Close observation and monitoring of
oxygen saturation, heart rate and
respiratory rate.
• Maintainance of optimal thermal
environment and minimal handling.
• Adequate warm and humidified O2 in high
concentration.
25. ….contd
• If oxygen saturation of blood cannot
maintained at a satisfactory level and carbon
dioxide level rises , infant will require
ventilator support.
• Tapping on the chest can be done to loosen
the secretions.
• Insert the nasogastric tube and keep the baby
nil per orally. It is advisable to perform gastric
lavage after the baby has been stabilized.
• Use of intravenous fluids until the respiratory
difficulty diminishes for fluid maintainance.
26. ……contd
• If there are no signs of respiratory distress,
just do suctioning and initiate
breastfeeding but monitor the baby's
condition closely.
• Monitoring of blood glucose as the infant
may be at increased risk of hypoglycaemia
after meconium aspiration.
• If hypoglycaemia exist then glucose
infusion is given through an intravenous
line.
27. …contd
• Monitoring of PaCO2 to detect worsening
respiratory acidosis. If respiratory acidosis
exists then intravenous administration of
7.5% sodium bicarbonate in dose of 3-8
meq/kg in 24 hours in 1:1 dilution with
distilled water is required.
• Systemic vasopressors i.e. nor epinephrine
are critical in maintaining systemic blood
pressure greater than pulmonary blood
pressure, thereby reducing right to left shunt
through patent ductus arteriosus.
29. ….contd
• Amnioinfusion
The infusion of warm isotonic fluid
transcervically during labour complicated
by meconium stained liquor has been
considered beneficial in reducing MAS.
The fetal heart rate and resting tone are
assessed continuously during the
intervention.
30. …contd
In patients with thick meconium fluid, an
infusion of 250 to 500 mL over 30 minutes,
followed by a constant infusion at 60 to
180 mL per hour, is the accepted protocol.
31. …...contd
• Ventilatory support
One third of infants with MAS require
ventilator support.
Continuous positive airway pressure (CPAP)
could be beneficial if air trapping is not a
major problem.
If CPAP does not suffice , mechanical
ventilation with low inspiratory pressure, short
inspiratory and long expiratory times and
rapid rates is required to maintain blood gas
within normal limits.
32. ..…contd
• Surfactant Therapy
• Broncho–alveolar Lavage
There is a high efficacy of lung lavage by
bronchoscopy in removing large quantities
of meconium and improving lung function
while the patient is on ventilator.
Surfactant is more effective than saline as
a lavage fluid.
33. …contd
• Inhaled Nitric Oxide
Inhaled nitric oxide is a pulmonary vasodilator
that is considered the most effective therapy in
the management of PPHN..
INO therapy may be used in conjunction with
surfactant replacement therapy, ventilation, or
ECMO.
The recommended dose of inhaled nitric oxide
is 20 PPM with gradual reduction of the dose
following improvement of oxygenation,
usually after 4-6 hours.
36. …contd
• Extra Corporeal Membrane Oxygenation
It is an extracorporeal technique of providing
prolonged cardiac and respiratory supports
to those whose heart and lungs are unable
to provide an adequate amount of gas
exchange or perfusion to sustain life.
ECMO provides oxygen to the circulation,
allows the lungs to rest and decreases
pulmonary hypertension and hypoxemia.
It is generally continued until the underlying
cardiac and lung problem is improved or
resolved.
37. Nursing Considerations
• Assessment of fetus and newborn.
• Airway clearance
• Maintainance of respiration
• Skin and mouth care
• Chest physiotherapy
• Carry out treatment protocol.
38. …contd
• Maintain nutrition
• Watch for signs of complications i.e. fever,
seizure, vomiting, breathing difficulties.
• Parental support
39. Prognosis
• The mortality rate of meconium-stained
infants is considerably higher than that of
non-stained infants.
• The ultimate prognosis depends on the
extent of CNS injury from asphyxia and
the presence of associated problems such
as pulmonary hypertension.
40. Complications
• Brain damage
• Parenchymal lung disease
• Persistent pulmonary hypertension of a
newborn
• Air block syndrome
• Pneumothorax, pneumomediastinum,
pneumopericardium
• Pulmonary interstitial emphysema
43. References
• Subedi, D.,& Gautam ,S.(2017) .Midwifery nursing part III ( 3rd
ed.). Medhavi Publication ,Baneshwor, Kathmandu,Nepal
(pp:248-250).
• Uprety,K. (2017).Essential of child health nursing(1st
ed.).Akshav Publication , kathmandu,Nepal (pp: 98-99).
• Koner,H.(Eds.).(2013).DC Dutta's textbook of obstetrics(8th
ed.).Jaypee Brothers Medical Publishers,New
Delhi,India(pp:550-551).
• Paul,V.K & Bagga.A.(2013).Ghai essential paediatrics(8th
ed.).CBS Publishers and Distributors, New Delhi, India(pp:
170).
• Sharma,R. (2013). Essential Paediatrics for Nurses( 2nd ed.).
Jyapee Brothers Medical Publisher , New Delhi,India( pp:222-
223).
44. • Hockenberry,M. & Wilson, D.(2013). Wong's Essential of
Pediatric Nursing(9th ed.). Library of Congress, United States
of America (pp:267-279)
• Thakur, L .(2012).Advanced child health nursing (3rd
ed.).Ultimate Marketing ,Lazimpat ,Kathmandu,Nepal (pp: 77-
79).
• Air Cmde U Raju, Maj V Sondhi, Maj SK Patnaik.Meconium
Aspiration Syndrome: An Insight. MJAFI 2010;66:152-157.
• Benjamin J Stenson, Allan D Jackson.Management of
Meconium Aspiration Syndrome.pediatrics and child health
2008;19: 174-176.
• Managing newborn problems.(2003).Geneva: Department of
reproductive health and research,WHO.
