Meconium is the first intestinal discharge of the newborn infant. In other words, it is the baby’s first stool, or “poop.” It is thick, sticky, tarry and is composed of epithelial cells, fetal hair, mucus, and bile. Intrauterine stress may cause the passage of meconium in utero. The meconium-stained amniotic fluid may be aspirated by the fetus when gasping or deep breathing movements are stimulated during birth. If meconium enters the airway during the baby’s first breaths of life, it can be inhaled deep into the lungs and get trapped. The meconium may stick to the air sacs (alveoli), making it hard for your baby to exchange oxygen. This can cause an airway obstruction as well as an inflammatory response, resulting in severe respiratory distress. Meconium Aspiration Syndrome (MAS) can be a warning sign of fetal distress and can indicate asphyxia. Most babies generally get better within a few days; however, in severe cases, it may cause pneumonia or lead to death.
MAS primarily affects term and post-term infants. Rarely does it occur in preemies. Symptoms depend on the severity of the hypoxic insult and the amount and viscosity of the meconium aspirated. Physical exam findings may include:
Tachypnea [rapid breathing]
Nasal flaring
Intercostal retractions
Cyanosis [bluish skin]
Grunting
Hyperinflated lungs and flattened diaphragm [due to trapped air]
Coarse, wet breath sounds
Pneumothorax or atelectasis present on x-ray
Treatment depends on the severity of the aspiration and how long the amniotic fluid was stained. This can include:
Early surfactant (Curosurf) administration in order to restore pulmonary function and prevent tissue injury. It should be given STAT to infants with respiratory distress or respiratory failure.
The initiation of oxygen therapy. Provide non-invasive respiratory support if the FiO2 requirements are <60% in order to keep SpO2 within target range. Provide ET intubation and mechanical ventilation if the FiO2 requirements are >60% to keep SpO2 within target range.
Frequent suctioning in order to facilitate airway clearance.
Supporting blood pressure via IV fluid boluses or vasopressors. Dopamine, Dobutamine or other inotropic agents may be necessary.
Providing fluid and electrolytes as needed
Providing antibiotics for sepsis management.
Providing pain medications and sedation as needed
Fun Fact: As long as I’ve been a nurse, I’ve proudly worn this badge reel as a representation of my personal mantra. “Meconium Happens” is my simple, existential observation that life is full of unpredictable events and we ought to just go with it ;) However, that’s not to say MAS should be perceived in a joking manner and shouldn’t be taken seriously. It’s just a lighthearted, comical anecdote symbolizing that “$#!+ happens!!!” ♥