Prevention and management of meconium aspiration syndrome
- Joseph A Garcia-Prats, MD
Joseph A Garcia-Prats, MD
- Section Editor — Neonatology
- Professor of Pediatrics
- Baylor College of Medicine
Meconium aspiration syndrome (MAS) is defined as respiratory distress in newborn infants born through meconium-stained amniotic fluid (MSAF) whose symptoms cannot be otherwise explained . MAS can present with varying degrees of severity from mild respiratory distress to life-threatening respiratory failure. Coordination of care between the obstetric and neonatal team is important to reduce the incidence of MAS, and to identify and provide emergent therapy in those who develop MAS to reduce morbidity and mortality .
The prevention, management, and outcome of MAS will be reviewed here. The pathophysiology, clinical features, and diagnosis of MAS are discussed separately. (See "Clinical features and diagnosis of meconium aspiration syndrome".)
Because of the potential for poor outcome, the best approach for managing MAS is prevention.
Intrapartum management — Intrapartum care to reduce the incidence of MAS includes:
●Prevention of fetal hypoxia, which is thought to be an important contributor to the pathogenesis of MAS (see "Clinical features and diagnosis of meconium aspiration syndrome", section on 'Pathophysiology')
- Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008; 28 Suppl 3:S3.
- Bhutani VK. Developing a systems approach to prevent meconium aspiration syndrome: lessons learned from multinational studies. J Perinatol 2008; 28 Suppl 3:S30.
- Hofmeyr GJ, Xu H, Eke AC. Amnioinfusion for meconium-stained liquor in labour. Cochrane Database Syst Rev 2014; :CD000014.
- Wiswell TE, Gannon CM, Jacob J, et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics 2000; 105:1.
- Niermeyer S, Kattwinkel J, Van Reempts P, et al. International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Contributors and Reviewers for the Neonatal Resuscitation Guidelines. Pediatrics 2000; 106:E29.
- Wiswell TE, Henley MA. Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome. Pediatrics 1992; 89:203.
- Carson BS, Losey RW, Bowes WA Jr, Simmons MA. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome. Am J Obstet Gynecol 1976; 126:712.
- Vain NE, Szyld EG, Prudent LM, et al. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet 2004; 364:597.
- Roggensack A, Jefferies AL, Farine D, et al. Management of meconium at birth. J Obstet Gynaecol Can 2009; 31:353.
- Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S543.
- Perlman JM, Wyllie J, Kattwinkel J, et al. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2015; 132:S204.
- Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infants born at term. Cochrane Database Syst Rev 2001; :CD000500.
- Chettri S, Adhisivam B, Bhat BV. Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial. J Pediatr 2015; 166:1208.
- Nangia S, Sunder S, Biswas R, Saili A. Endotracheal suction in term non vigorous meconium stained neonates-A pilot study. Resuscitation 2016; 105:79.
- van Ierland Y, de Boer M, de Beaufort AJ. Meconium-stained amniotic fluid: discharge vigorous newborns. Arch Dis Child Fetal Neonatal Ed 2010; 95:F69.
- Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics 1990; 85:715.
- Singh BS, Clark RH, Powers RJ, Spitzer AR. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol 2009; 29:497.
- El Shahed AI, Dargaville P, Ohlsson A, Soll RF. Surfactant for meconium aspiration syndrome in full term/near term infants. Cochrane Database Syst Rev 2007; :CD002054.
- Polin RA, Carlo WA, Committee on Fetus and Newborn, American Academy of Pediatrics. Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics 2014; 133:156.
- Findlay RD, Taeusch HW, Walther FJ. Surfactant replacement therapy for meconium aspiration syndrome. Pediatrics 1996; 97:48.
- Hahn S, Choi HJ, Soll R, Dargaville PA. Lung lavage for meconium aspiration syndrome in newborn infants. Cochrane Database Syst Rev 2013; :CD003486.
- Lam BC, Yeung CY. Surfactant lavage for meconium aspiration syndrome: a pilot study. Pediatrics 1999; 103:1014.
- Dargaville PA, Copnell B, Mills JF, et al. Randomized controlled trial of lung lavage with dilute surfactant for meconium aspiration syndrome. J Pediatr 2011; 158:383.
- Davis PJ, Shekerdemian LS. Meconium aspiration syndrome and extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2001; 84:F1.
- Friedlich P, Noori S, Stein J, et al. Predictability model of the need for extracorporeal membrane oxygenation in neonates with meconium aspiration syndrome treated with inhaled nitric oxide. J Pediatr Surg 2005; 40:1090.
- Radhakrishnan RS, Lally PA, Lally KP, Cox CS Jr. ECMO for meconium aspiration syndrome: support for relaxed entry criteria. ASAIO J 2007; 53:489.
- Kugelman A, Gangitano E, Taschuk R, et al. Extracorporeal membrane oxygenation in infants with meconium aspiration syndrome: a decade of experience with venovenous ECMO. J Pediatr Surg 2005; 40:1082.
- Goel A, Nangia S, Saili A, et al. Role of prophylactic antibiotics in neonates born through meconium-stained amniotic fluid (MSAF)--a randomized controlled trial. Eur J Pediatr 2015; 174:237.
- Yeh TF, Srinivasan G, Harris V, Pildes RS. Hydrocortisone therapy in meconium aspiration syndrome: a controlled study. J Pediatr 1977; 90:140.
- Ward M, Sinn J. Steroid therapy for meconium aspiration syndrome in newborn infants. Cochrane Database Syst Rev 2003; :CD003485.
- Macfarlane PI, Heaf DP. Pulmonary function in children after neonatal meconium aspiration syndrome. Arch Dis Child 1988; 63:368.
- Swaminathan S, Quinn J, Stabile MW, et al. Long-term pulmonary sequelae of meconium aspiration syndrome. J Pediatr 1989; 114:356.
- Yuksel B, Greenough A, Gamsu HR. Neonatal meconium aspiration syndrome and respiratory morbidity during infancy. Pediatr Pulmonol 1993; 16:358.
- Beligere N, Rao R. Neurodevelopmental outcome of infants with meconium aspiration syndrome: report of a study and literature review. J Perinatol 2008; 28 Suppl 3:S93.
- Intrapartum management
- - Prevention of fetal hypoxia
- - Prevention of postmature delivery
- - Amnioinfusion
- Delivery room management
- - Obstetrical care
- - Neonatal care
- Post-delivery room
- Respiratory management
- - Oxygen therapy
- - Assisted ventilation
- - Surfactant
- - Nitric oxide
- - Extracorporeal membrane oxygenation (ECMO)
- Circulatory support
- Pulmonary sequelae
- Neurologic outcome
- SUMMARY AND RECOMMENDATIONS