Clinical features and diagnosis 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.
The clinical features and diagnosis of MAS will be discussed here. The management and complications of MAS are discussed elsewhere. (See "Prevention and management of meconium aspiration syndrome".)
In the United States, a retrospective multicenter study of 162,075 term infants born between 1997 and 2007 reported 1.8 percent of infants had an admission diagnosis of MAS .
MAS occurs in approximately 2 to 10 percent of infants born through meconium-stained amniotic fluid (MSAF). This was illustrated in a study from a single tertiary center of 20,047 live births between 1994 and 1998 that reported MSAF occurring in 9.2 percent and MAS in 0.1 percent of all live births .
This 10-fold difference in the incidence of MAS may be due to differences between the two studies in the rigor that MAS was diagnosed and measures used to prevent MAS. (See "Prevention and management of meconium aspiration syndrome", section on 'Prevention'.)
- Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008; 28 Suppl 3:S3.
- 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.
- Whitfield JM, Charsha DS, Chiruvolu A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. Proc (Bayl Univ Med Cent) 2009; 22:128.
- Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117:828.
- Clausson B, Cnattingius S, Axelsson O. Outcomes of post-term births: the role of fetal growth restriction and malformations. Obstet Gynecol 1999; 94:758.
- Yoder BA, Kirsch EA, Barth WH, Gordon MC. Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome. Obstet Gynecol 2002; 99:731.
- Dargaville PA, Copnell B, Australian and New Zealand Neonatal Network. The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome. Pediatrics 2006; 117:1712.
- Davis PJ, Shekerdemian LS. Meconium aspiration syndrome and extracorporeal membrane oxygenation. Arch Dis Child Fetal Neonatal Ed 2001; 84:F1.
- Cleary GM, Wiswell TE. Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update. Pediatr Clin North Am 1998; 45:511.
- Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics 1990; 85:715.
- Wiswell TE, Bent RC. Meconium staining and the meconium aspiration syndrome. Unresolved issues. Pediatr Clin North Am 1993; 40:955.
- RAPOPORT S, BUCHANAN DJ. The composition of Meconium; isolation of blood-group-specific polysaccharides; abnormal compositions of meconium in meconium ileus. Science 1950; 112:150.
- Côté RH, Valet JP. Isolation, composition and reactivity of the neutral glycoproteins from human meconiums with specificities of the ABO and Lewis systems. Biochem J 1976; 153:63.
- Sienko A, Altshuler G. Meconium-induced umbilical vascular necrosis in abortuses and fetuses: a histopathologic study for cytokines. Obstet Gynecol 1999; 94:415.
- Hsieh TT, Hsieh CC, Hung TH, et al. Differential expression of interleukin-1 beta and interleukin-6 in human fetal serum and meconium-stained amniotic fluid. J Reprod Immunol 1998; 37:155.
- Cayabyab RG, Kwong K, Jones C, et al. Lung inflammation and pulmonary function in infants with meconium aspiration syndrome. Pediatr Pulmonol 2007; 42:898.
- Sippola T, Aho H, Peuravuori H, et al. Pancreatic phospholipase A2 contributes to lung injury in experimental meconium aspiration. Pediatr Res 2006; 59:641.
- Mulivor RA, Mennuti MT, Harris H. Origin of the alkaline phosphatases in amniotic fluid. Am J Obstet Gynecol 1979; 135:77.
- Abramovich DR, Gray ES. Physiologic fetal defecation in midpregnancy. Obstet Gynecol 1982; 60:294.
- Matthews TG, Warshaw JB. Relevance of the gestational age distribution of meconium passage in utero. Pediatrics 1979; 64:30.
- Miller FC. Meconium staining of the aminiotic fluid. Clin Obstet Gynaecol 1979; 6:359.
- Yeomans ER, Gilstrap LC 3rd, Leveno KJ, Burris JS. Meconium in the amniotic fluid and fetal acid-base status. Obstet Gynecol 1989; 73:175.
- Lucas A, Christofides ND, Adrian TE, et al. Fetal distress, meconium, and motilin. Lancet 1979; 1:718.
- Mahmoud EL, Benirschke K, Vaucher YE, Poitras P. Motilin levels in term neonates who have passed meconium prior to birth. J Pediatr Gastroenterol Nutr 1988; 7:95.
- Dawes GS, Fox HE, Leduc BM, et al. Respiratory movements and rapid eye movement sleep in the foetal lamb. J Physiol 1972; 220:119.
- Block MF, Kallenberger DA, Kern JD, Nepveux RD. In utero meconium aspiration by the baboon fetus. Obstet Gynecol 1981; 57:37.
- Hooper SB, Harding R. Changes in lung liquid dynamics induced by prolonged fetal hypoxemia. J Appl Physiol (1985) 1990; 69:127.
- Boddy K, Dawes GS. Fetal breathing. Br Med Bull 1975; 31:3.
- Manning FA, Martin CB Jr, Murata Y, et al. Breathing movements before death in the primate fetus (Macaca mulatta). Am J Obstet Gynecol 1979; 135:71.
- Brown BL, Gleicher N. Intrauterine meconium aspiration. Obstet Gynecol 1981; 57:26.
- Byrne DL, Gau G. In utero meconium aspiration: an unpreventable cause of neonatal death. Br J Obstet Gynaecol 1987; 94:813.
- Sunoo C, Kosasa TS, Hale RW. Meconium aspiration syndrome without evidence of fetal distress in early labor before elective cesarean delivery. Obstet Gynecol 1989; 73:707.
- Ghidini A, Spong CY. Severe meconium aspiration syndrome is not caused by aspiration of meconium. Am J Obstet Gynecol 2001; 185:931.
- Tran N, Lowe C, Sivieri EM, Shaffer TH. Sequential effects of acute meconium obstruction on pulmonary function. Pediatr Res 1980; 14:34.
- Tyler DC, Murphy J, Cheney FW. Mechanical and chemical damage to lung tissue caused by meconium aspiration. Pediatrics 1978; 62:454.
- Dargaville PA, South M, McDougall PN. Surfactant and surfactant inhibitors in meconium aspiration syndrome. J Pediatr 2001; 138:113.
- Yamada T, Minakami H, Matsubara S, et al. Meconium-stained amniotic fluid exhibits chemotactic activity for polymorphonuclear leukocytes in vitro. J Reprod Immunol 2000; 46:21.
- de Beaufort AJ, Pelikan DM, Elferink JG, Berger HM. Effect of interleukin 8 in meconium on in-vitro neutrophil chemotaxis. Lancet 1998; 352:102.
- Yamada T, Matsubara S, Minakami H, et al. Chemotactic activity for polymorphonuclear leukocytes: meconium versus meconium-stained amniotic fluid. Am J Reprod Immunol 2000; 44:275.
- Romero R, Hanaoka S, Mazor M, et al. Meconium-stained amniotic fluid: a risk factor for microbial invasion of the amniotic cavity. Am J Obstet Gynecol 1991; 164:859.
- Rao S, Pavlova Z, Incerpi MH, Ramanathan R. Meconium-stained amniotic fluid and neonatal morbidity in near-term and term deliveries with acute histologic chorioamnionitis and/or funisitis. J Perinatol 2001; 21:537.
- Mazor M, Furman B, Wiznitzer A, et al. Maternal and perinatal outcome of patients with preterm labor and meconium-stained amniotic fluid. Obstet Gynecol 1995; 86:830.
- Bryan CS. Enhancement of bacterial infection by meconium. John Hopkins Medical Journal 1967; 121:9.
- Clark P, Duff P. Inhibition of neutrophil oxidative burst and phagocytosis by meconium. Am J Obstet Gynecol 1995; 173:1301.
- Chen CT, Toung TJ, Rogers MC. Effect of intra-alveolar meconium on pulmonary surface tension properties. Crit Care Med 1985; 13:233.
- Clark DA, Nieman GF, Thompson JE, et al. Surfactant displacement by meconium free fatty acids: an alternative explanation for atelectasis in meconium aspiration syndrome. J Pediatr 1987; 110:765.
- Davey AM, Becker JD, Davis JM. Meconium aspiration syndrome: physiological and inflammatory changes in a newborn piglet model. Pediatr Pulmonol 1993; 16:101.
- Hall SB, Notter RH, Smith RJ, Hyde RW. Altered function of pulmonary surfactant in fatty acid lung injury. J Appl Physiol (1985) 1990; 69:1143.
- al-Mateen KB, Dailey K, Grimes MM, Gutcher GR. Improved oxygenation with exogenous surfactant administration in experimental meconium aspiration syndrome. Pediatr Pulmonol 1994; 17:75.
- Janssen DJ, Carnielli VP, Cogo P, et al. Surfactant phosphatidylcholine metabolism in neonates with meconium aspiration syndrome. J Pediatr 2006; 149:634.
- BROWN CA, DESMOND MM, LINDLEY JE, MOORE J. Meconium staining of newborn infants. J Pediatr 1956; 49:540.
- 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.
- 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.
- Gooding CA, Gregory GA. Roentgenographic analysis of meconium aspiration of the newborn. Radiology 1971; 100:131.
- PETERSON HG Jr, PENDLETON ME. Contrasting roentgenographic pulmonary patterns of the hyaline membrane and fetal aspiration syndromes. Am J Roentgenol Radium Ther Nucl Med 1955; 74:800.
- Yeh TF, Harris V, Srinivasan G, et al. Roentgenographic findings in infants with meconium aspiration syndrome. JAMA 1979; 242:60.
- Wiswell TE, Henley MA. Intratracheal suctioning, systemic infection, and the meconium aspiration syndrome. Pediatrics 1992; 89:203.
- Composition of meconium
- Meconium passage
- Pulmonary disease
- - Airway obstruction
- - Chemical irritation and inflammation
- - Infection
- - Surfactant
- CLINICAL FEATURES
- Pulmonary findings
- DIFFERENTIAL DIAGNOSIS
- SUMMARY AND RECOMMENDATIONS