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About Meconium Aspiration (MAS) – Part 2

• MAS can happen before, during, or after labor.
• It can happen even after delivery when a newborn inhales (or aspirates) a mixture of meconium and amniotic fluid.
• Meconium is the baby’s first feces, or poop.
• This is sticky, thick, and dark green substance.
• It is typically passed in the womb during early pregnancy and again in the first few days after birth.
• The inhaled meconium can partially or completely block the baby’s airways.
• The meconium becomes trapped in the airways when the baby breathes out.
• The inhaled meconium irritates the baby’s airways and makes it difficult to breathe.
• MAS can affect the baby’s breathing in a number of ways.

Signs and Symptoms for Meconium Aspiration (MAS)

• Meconium or dark green streaks or stains in the amniotic fluid.
• Discoloration of the baby’s skin — either blue (cyanosis) or green.
• Problems with breathing — including rapid breathing (tachypnea), labored (difficulty) breathing, or suspension of breathing (apnea).
• Low heart rate in the baby before birth.
• Low Apgar score- the Apgar test is given to newborns just after birth to quickly evaluate color, heartbeat, reflexes, muscle tone, and breathing.
• Limpness in the baby.
• Postmaturity (signs that a baby is overdue such as long nails).

Diagnosis of Meconium Aspiration (MAS)

• If a baby is thought to have inhaled meconium, treatment will begin during delivery.
• If the baby has any depression in breathing, the doctor taking care of the baby will insert a laryngoscope into the baby’s trachea.
• This is to remove any meconium that might be present.
• The doctor will also probably listen to the baby’s chest with a stethoscope.
• The doctor takes a note for sounds in the lungs that are common in infants with MAS.
• The doctor may also order tests.
• This is a blood test (called a blood gas analysis) that helps determine if the baby is getting enough oxygen and a chest X-ray that can show patches or streaks on the lungs that are found in babies with MAS.

Treatment of Meconium Aspiration (MAS)

• If an infant has inhaled meconium but looks active, appears well, and has a strong heartbeat, the delivery team can watch the baby for MAS symptoms.
• These symptoms typically appear within the first 24 hours.
• The baby is observed for signs like increased respiratory rate, grunting, or cyanosis.
• For an infant that has inhaled meconium and shows signs of poor activity level and has a lower heart rate, then the the baby is limp, and has poor muscle tone.
• The goal is to clear the airway as much as possible to decrease the amount of meconium that’s aspirated.
• This is done by putting in an endotracheal tube.
• This is a plastic tube that’s placed into the baby’s windpipe through the mouth or nose and applying suction as the tube is slowly removed.
• This allows the infant to receive suctioning of both the upper and lower airways.
• The doctor will continue trying to clear the airway until there’s no meconium in the suctioned fluids.
• Most babies with MAS improves within a few days or weeks.
• This depends on the severity of the aspiration.
• A baby’s rapid breathing may continue for days after birth but there’s usually no severe permanent lung damage.
• There are studies, however, indicating that those born with MAS are at a higher risk of having reactive airway disease.
• This is because the lungs are more sensitive and can possibly lead to an asthmatic condition.
• Babies with MAS may be sent to a special care nursery or a neonatal intensive care unit (NICU) to be closely monitored for the next few days.

Treatments may include:
• Oxygen therapy by oxygen hood or ventilation.
• Antibiotics.
• Use of surfactant.
• Nitric oxide.
• Obtaining blood routinely to determine if the baby is receiving enough oxygen.

Nursing Diagnosis Handbook The Birth Partner, Third Edition Meconium Aspiration Syndrome

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