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About Meconium Aspiration (MAS) – Part 3

• 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.

What is Severe Aspiration?

• Babies who have severe aspiration and require mechanical ventilation are at increased risk for bronchopulmonary dysplasia.
• This is a lung condition that can be treated with medication or oxygen.
• Another complication associated with MAS is a collapsed lung.
• This is also known as pneumothorax, a collapsed lung is treated by reinflating the lung.
• This is done by inserting a tube between the ribs, allowing the lung to gradually re-expand.
• A small percentage of babies with severe MAS develop aspiration pneumonia.
• If this occurs, the doctor may recommend advanced lung rescue therapy.

What therapies are used to treat different forms of MAS?

Three therapies are currently used to treat aspiration pneumonia and severe forms of MAS:
1. Surfactant therapy
• This is an artificial surfactant that is instilled into the baby’s lungs.
• This will help to keep the air sacs open.

2. High-frequency oscillation
This is a special ventilator that vibrates air enriched with extra oxygen into the baby’s lungs.

3. Rescue therapy
• Nitric oxide is added to the oxygen in the ventilator.
• It dilates the blood vessels and allows more blood flow and oxygen to reach the baby’s lungs.

If one of these therapies (or a combination of them) doesn’t work, there is another alternative therapy which is:
4. Extra corporeal membrane oxygenation (ECMO)
• This is a form of cardiopulmonary bypass.
• This is a process where an artificial heart and lung will temporarily take over to supply blood flow to the baby’s body.
• ECMO reduces the fatality rate for these severely distressed infants from 80% to 10%.
• Not all hospitals are ECMO centers.
• Babies with severe cases of MAS may come home from the hospital on oxygen.
• They may be more likely to have wheezing and lung infections during their first year.
• Lungs can regenerate new air sacs, so the long-term prognosis for their lungs is excellent.

What are possible Long-Term Complications?

• Severely affected babies are at risk for developing chronic lung disease.
• They may also have developmental abnormalities and hearing loss.
• Babies diagnosed with MAS will be screened at the hospital for hearing problems or neurological damage.
• Severe cases of MAS may be fatal.
• Through interventions such as suctioning and reducing the number of post-term births, the cases of MAS have reduced.

How to prevent Meconium Aspiration?

• It’s important for a pregnant woman to tell her doctor immediately if meconium is present in the amniotic fluid when her water breaks.
• This is true even when the fluid has dark green stains or streaks.
• Doctors also use a fetal monitor during labor to observe the baby’s heart rate for any signs of fetal distress.
• In some cases doctors may recommend amnioinfusion.
• This is the dilution of the amniotic fluid with saline to wash meconium out of the amniotic sac before the baby has a chance to inhale it at birth.
• Most infants are monitored for fetal distress during labor, and doctors pay careful attention to any signs that would indicate meconium aspiration.

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

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