Meconium aspiration syndrome

Meconium aspiration syndrome
Micrograph of fetal membranes with meconium-laden macrophages, a finding that may accompany meconium aspiration. H&E stain.
Classification and external resources
Specialty	pediatrics
ICD-10	P24.0
ICD-9-CM	770.11, 770.12
DiseasesDB	7907
MedlinePlus	001596
eMedicine	ped/768
MeSH	D008471
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Meconium aspiration syndrome (MAS) also known as neonatal aspiration of meconium is a medical condition affecting newborn infants. It occurs when meconium is present in their lungs during or before delivery. Meconium is the first stool of an infant, composed of materials ingested during the time the infant spends in the uterus.

Meconium is normally stored in the infant's intestines until after birth, but sometimes (often in response to fetal distress and hypoxia) it is expelled into the amniotic fluid prior to birth, or during labor. If the baby then inhales the contaminated fluid, respiratory problems may occur.

The most obvious sign that meconium has been passed during or before labor is the greenish or yellowish appearance of the amniotic fluid. The infant's skin, umbilical cord, or nailbeds may be stained green if the meconium was passed a considerable amount of time before birth. These symptoms alone do not necessarily indicate that the baby has inhaled in the fluid by gasping in utero or after birth. After birth, rapid or labored breathing, cyanosis, slow heartbeat, a barrel-shaped chest or low Apgar score are all signs of the syndrome. Inhalation can be confirmed by one or more tests such as using a stethoscope to listen for abnormal lung sounds (diffuse 'wet' crackles and rhonchi), performing blood gas tests to confirm a severe loss of lung function (respiratory acidosis as a consequence of hypercapnia), and using chest X-rays to look for patchy or streaked areas on the lungs. Infants who have inhaled meconium may develop respiratory distress syndrome often requiring ventilatory support. Complications of MAS include pneumothorax and persistent pulmonary hypertension of the newborn.

Fetal distress during labor causes intestinal contractions, as well as relaxation of the anal sphincter, which allows meconium to pass into the amniotic fluid and contaminate the amniotic fluid. Meconium passage into the amniotic fluid occurs in about 5–20 percent of all births and is more common in overdue births. Of the cases where meconium is found in the amniotic fluid, meconium aspiration syndrome develops less than 5 percent of the time. Amniotic fluid is normally clear, but becomes greenish if it is tinted with meconium.

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