Should parents be concerned if their child has been diagnosed with meconium aspiration syndrome?
Meconium aspiration syndrome (MAS) is a condition where a newborn breathes meconium (newborn’s first stools – thick, sticky, greenish-black color) and amniotic fluid into the lungs before, during, or after delivery. When a baby is under stress or not receiving enough oxygen or blood, the baby can pass feces while still in the uterus.
Once this happens, the baby can breathe the meconium and amniotic fluid into its lungs. About 6-25% of delivered babies have meconium stained amniotic fluid, but only 2-36% of these newborns actually aspirate meconium. According to Johns Hopkins, MAS only occurs in about 5-10% of births.
This is a very serious condition because it usually occurs when a fetus is in distress. MAS can cause breathing difficulties, block the baby’s airways after birth, and lead to permanent lung damage, brain injury, or even death. Risk factors include:
- Long and difficult labor
- Decreased oxygen to fetus (fetal hypoxia)
- Placental insufficiency
- Maternal high blood pressure (preeclampsia)
- Maternal diabetes
- Maternal drug abuse (tobacco or cocaine)
- Postmaturity (overdue baby, more than 40 weeks gestational)
A sign of a medical error?
If a baby does pass stool while still in the uterus, it can be a sign that something was not done right during delivery. This is because meconium aspiration syndrome usually occurs when the fetus is in distress (fetal hypoxic stress). Doctors and health care providers must closely monitor labor and delivery to ensure that the fetus is not in distress.
Fetal monitoring should be done in order to prevent dangerous complications. If the baby is not receiving enough blood or oxygen or if the heart rate is slow, doctors must act quickly to restore blood flow/oxygen it in order to prevent brain damage. If blood and/or oxygen cannot be restored, an emergency delivery should be performed (usually a c-section). A delay in response can cause significant brain damage and injury.
Respiratory problems in child
If a baby is born and appears to be suffering from respiratory problems, the health care providers should suction the newborn’s mouth as soon as the head emerges. If the baby is not breathing, a tube must be placed in the infant’s trachea and suction applied until no more meconium is seen in the suction contents. Infants are no longer supposed to receive intrapartum suctioning if they have meconium-stained amniotic fluid because it can cause pneumonia. Then, the newborn should be placed in intensive care or similar unit for close observation. Some babies may need oxygen or a ventilator, and antibiotics.
In most cases of MAS, if proper treatment is provided, any breathing problems usually clear in about two to four days. However, if a newborn suffered severe aspiration, the lack of oxygen can cause brain damage. Typically, the longer the newborn is without oxygen, the more serious the outcome.
Identifying medical error in meconium aspiration cases
Medical errors can cause serious problems during delivery, especially when doctors or nurses fail to recognize and react to respiratory problems in the newborn. Serious injury can occur if health care providers do not react quickly to the presence of meconium. If the newborn’s airways are not cleared quickly, the baby can suffer from airway obstruction. In addition, the meconium can cause swelling in the infant’s lungs after birth, which can also cause respiratory problems. Early treatment is key in preventing life long complications from meconium aspiration.
- Pub Med: Meconium aspiration syndrome
- MedlinePlus: Meconium aspiration syndrome
- Johns Hopkins Children’s Center: Meconium Aspiration Syndrome
- eMedicine: Meconium Aspiration Syndrome
- Merck Manuals: Meconium Aspiration Syndrome
- K.D. Ramin et al., Amniotic Fluid Meconium: A Fetal Environmental Hazard, 87(2) OBSTET. GYNECOL. 181-84 (Feb. 1996).
- Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 379: Management of delivery of a newborn with meconium-stained amniotic fluid. Obstet Gynecol. 2007; 110:739.