Meconium-stained Liquor and Meconium Aspiration

 

Reviewed by David Knight
October
2004
Clinical Guidelines Back Newborn Services Home Page
Delivery Room Management Further Management Criteria for Admission to NICU
Management of the Symptomatic  Infant Complications of Meconium Aspiration References

Delivery Room Management

  1. The Paediatric Resident (SHO, Registrar, or NS-ANP) should be called if there is thick meconium staining or light meconium plus fetal distress.
  2. There is no advantage in oral and pharyngeal suction as the head delivers and this is no longer indicated. 1 
    Suctioning does not alter the chance of developing respiratory distress or symptomatic meconium aspiration syndrome, even in sub-groups with thick meconium, fetal distress or delivered by Caesarean section.
  3. If the baby is apparently vigorous at birth (heart rate >100, spontaneous respiration, reasonable tone), intubation and tracheal suction is not indicated, unless the baby subsequently has poor respiratory effort or early respiratory distress. 2
    Intubation of vigorous babies does not improve respiratory outcomes and can result in trauma to the infant.
  4. Intubation and tracheal suction should be performed if the baby has moderate or thick meconium and depression at birth.
  1. Assess the infant.
    Arrange for cord blood gas (arterial if possible) to be taken from a double clamped section of cord.

Further Management

Criteria for Admission to NICU

Management of the Symptomatic Infant

Complications of Meconium Aspiration

  1. Infection: Uncommon unless sepsis was the stimulus to make the infant pass meconium. Consider LISTERIA, especially if preterm. Meconium is a good culture medium so secondary infection may occur.
  2. Pneumothorax: May occur at any stage (MAS is an air-trapping disease). So consider this any time from resuscitation onwards if there is unexpected deterioration or significant disease.
  3. Respiratory Failure: Can occur because of respiratory obstruction, inflammation, infection or shunting.
  4. Persistent Pulmonary Hypertension: Is common in severe MAS and can be very difficult to treat. Early assessment and avoidance of hypoxaemia, hypothermia, hypoglycaemia are important to avert PPHN.

References

1 Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Vane NE, Szyld EG, et al. Lancet 2004: 364: 597-602
2 Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Wiswell TE, Gannon CM, Jacob J, et al.  Pediatrics 2000; 105:1-7.
3 Clinical audit of babies delivered through meconium stained liquor.  Ashton M.  NWH 2001