Meconium Aspiration 101
In modern medicine, the term meconium aspiration refers to the so-called respiratory distress syndrome in newborns. The respiratory distress syndrome appears immediately after the birth of the newborn and is always based on impaired lung function.
What is meconium aspiration?
Meconium aspiration occurs in about 10 to 15 percent of all recorded births. Since the lungs of the newborn cannot fully develop, especially in the context of a premature birth, a so-called respiratory distress syndrome occurs. See AbbreviationFinder for abbreviations related to Meconium Aspiration.
The unborn child comes into contact with the individual meconium particles in the amniotic fluid. It is not uncommon for newborns to be born unconscious. This condition requires immediate resuscitation. In most cases, however, the so-called respiratory distress syndrome only appears after several hours.
If an infection occurs as part of a meconium aspiration, there is an acute danger to the life of the newborn. The said infection often develops into pneumonia, which in the worst case can lead to death.
Causes
The so-called meconium particles are largely responsible for the occurrence of a so-called meconium aspiration. Doctors usually use the term meconium to describe the first bowel movement in the unborn child.
As early as the sixteenth week of pregnancy, feces can enter the amniotic fluid. Feces often pass into the amniotic fluid in the context of a stressful situation. As a result of this process, the amniotic fluid usually turns green. If meconium aspiration is suspected, a comprehensive investigation must be undertaken.
Symptoms, Ailments & Signs
A meconium aspiration is a medical emergency that manifests itself in severe breathing problems, cyanosis and possibly shock symptoms. The newborn child appears limp because there is no muscle tone or only a greatly reduced muscle tone. The child’s breathing is barely perceptible.
It doesn’t cry like normal newborns, it just whimpers. Indentations are observed in the diaphragm, jugulum, and intercostal spaces. The skin and mucous membranes are blue in color due to the lack of oxygen. The amniotic fluid is green in color at birth because it contains meconium. The child’s skin is visibly smeared with meconium.
The meconium is found in skin folds, in the ears, inside the nostrils, and in the mouth and throat. The skin, umbilical cord and nails are often green in color, which indicates that meconium was passed a long time ago. However, the passage of meconium can also have taken place shortly before birth. The severity of the cardiovascular problems depends on the duration and severity of the shortness of breath.
In particularly severe cases, the child is born unconscious due to a significant prenatal lack of oxygen. Immediate resuscitation is then required. A valve effect of the meconium leads to overinflation of the lungs and a pneumothorax.
Overstretched air sacs can rupture, and the air then gets into the connective tissue of the lungs, causing interstitial pulmonary emphysema. This and the possible development of pneumonia due to the accumulation of meconium in the airways often create an acute life-threatening situation for the newborn.
Diagnosis & History
The diagnosis of a so-called meconium aspiration is made during an initial clinical examination of the child. During this examination, the child’s glottis is examined, among other things. If green water is found behind the glottis, doctors speak of meconium aspiration.
A chest x-ray is considered to confirm the initial suspicion of meconium aspiration. Using the imaging method, suspicious shadows on the lungs can be revealed. In most cases, the shading is limited to a specific area of the lungs. However, if the shades affect the entire lung, modern medicine speaks of a so-called white lung.
Any existing pneumonia can no longer be clearly identified in this case. To avoid possible late effects, meconium aspiration requires immediate and extensive therapy.
Complications
Due to meconium aspiration, newborns suffer from various ailments. If these symptoms are not treated, the worst case scenario can be the death of the child. As a rule, the child shows no signs of life immediately after birth and also no normal breathing. The skin and fingernails are also stained blue due to the breathing difficulties. The children cannot scream either, they only whimper and appear very weak and exhausted.
Meconium aspiration usually requires immediate treatment by a doctor to prevent death of the patient or further consequential damage in adulthood. The parents or relatives of the child in particular can suffer from severe psychological symptoms or from depression and anxiety as a result of the symptoms of meconium aspiration.
The treatment itself is carried out with the help of a surgical procedure. This usually leads to success, although complications rarely occur. The patient may need artificial respiration. Psychological complaints of parents and relatives must also be treated, although in most cases the disease progresses positively.
When should you go to the doctor?
If the newborn child has shortness of breath, emergency medical care must be initiated immediately so that the infant does not die suddenly. In the case of an inpatient birth, the nurses and doctors who are present take care of the child’s first aid. You notice the discrepancies immediately during the birth process and independently initiate the necessary steps for an adequate oxygen supply. If the birth takes place in a birthing center or if a home birth is carried out, the midwife or other obstetricians will notice that the breathing activity is disturbed. They also initiate the necessary steps for adequate care of the newborn independently and without further requests.
In addition, a rescue service must be alerted and first aid measures must be taken. Parents should follow the instructions of the nursing and care staff and comply with their calls for action. In the event of a sudden and unplanned birth, the mother or other persons present must call an ambulance as soon as possible. Until it arrives, the child’s oxygen supply must be secured by mouth-to-mouth resuscitation. The child is often born unconscious. Therefore, there is an acute need for action and emergency care is required. Blue discoloration of the skin is cause for concern. Breathing activity must be checked immediately.
Treatment & Therapy
Meconium aspiration is always treated in a so-called perinatal center. In addition to the technical equipment, the personnel equipment in a perinatal center is designed for the treatment of meconium aspiration.
Depending on the severity, a so-called CPAP ventilation is started via the nose. As part of this therapy method, the newborn is supported in the exhalation phase by actively exerting pressure. If respiratory distress syndrome is severe, endotracheal intubation combined with mechanical ventilation is considered. Mechanical ventilation intervenes to support both the inhalation phase and the exhalation phase.
All measures mentioned always require a so-called pulse oximetry. As part of the so-called pulse oximetry, the child’s heart rate is monitored in addition to the oxygen saturation of the blood. Simultaneously monitoring blood pressure is essential.
Outlook & Forecast
If left untreated, meconium aspiration inevitably leads to the premature death of the affected person. The infant’s respiratory supply is restricted, thereby causing death. First aid measures must be applied in order to have a chance of survival. If the course of the disease is unfavorable, a life-threatening condition and thus premature death can occur even after the acute period. There is an increased risk of developing pneumonia.
This requires medical care, especially in newborns, to ensure survival. Artificial respiration is mandatory for this disease. Otherwise, death will occur within minutes. Therefore, the general health of the child is crucial for a prognosis. It is improved when there are no other health restrictions. It must also be ensured that adequate medical care is provided within a few minutes. With a spontaneous birth without the presence of obstetricians, an unfavorable prognosis is given.
Newborns who are born in an inpatient setting have the best chance of survival. As soon as the acute phase is over and no pneumonia develops, the further course is positive. Within a short time there is a significant alleviation of the symptoms and recovery. Nevertheless, the infant’s cardiovascular system should be monitored over a longer period of time.
Prevention
Basically, meconium aspiration cannot be actively prevented. However, the resulting respiratory distress syndrome can be treated preventively, especially in the event of a possible premature birth. If a premature birth is expected, the physicians consider administering betamethasone.
The purpose of administering the special preparation is to actively support the lung maturation of the unborn child. In addition to betamethasone, the agent tocolysis is used, among other things. By administering tocolysis, the time of birth can be postponed in most cases.
The time gained should actively contribute to the maturation process of the lungs. In addition, extensive perinatal care and gentle initiation of the forthcoming birth can noticeably reduce the risk of developing respiratory distress syndrome.
Aftercare
A meconium aspiration can lead to a number of different symptoms or complications, which, however, depend very much on the exact cause and also on the severity of the disease. Because treatment is relatively complex and lengthy, follow-up care also focuses on managing the condition well. Those affected should try to focus on a positive healing process despite the adversity. To establish the right attitude, relaxation exercises and meditation can help calm and focus the mind. This is a basic prerequisite for recovery and helps to deal with the hardships more easily. Sudden symptoms should be clarified immediately with the doctor. If a recovery has largely taken place,
You can do that yourself
After the initial treatment of meconium aspiration, the parents can take various measures to support the healing process and avoid any subsequent problems. First of all, good monitoring of the newborn is important. If any unusual symptoms appear, the family doctor must be contacted, who will, if necessary, carry out a further examination and prescribe a suitable medication for the child. Since affected children are usually also physically injured, stress and exertion should be avoided.
Despite all measures, the child can be prone to asthma later in life. Parents should find out about the respiratory disease at an early stage and take preparatory measures. An asthma spray and other medication are best organized as a preventative measure, so that you can react quickly in the event of a first attack.
If serious complications occur later on, intensive care treatment is indicated. If the course is severe, the parents may need therapeutic support. Support groups are a good way to talk to other affected parents and share experiences. The parents can find out exactly which measures are sensible and necessary in a discussion with the responsible doctor and a therapist.
