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The Neonate
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Laura De Angelis, Luca Ramenghi
Meconium is the first intestinal discharge of newborn infants, normally expelled within the first 24 hours from birth. It is a thick, dark-greenish mass composed of substances ingested during the intrauterine life, including intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Intrauterine or intrapartum stress may cause the meconium to be expelled before birth. Meconium-stained fluid is present in 8%–20% of deliveries, and it is almost exclusively found in term or postterm infants. Meconium aspiration syndrome occurs intrapartum when a newborn infant breathes a mixture of meconium or meconium-stained amniotic fluid. The presence of meconium in the lungs may cause bronchial obstruction and lung inflammation, leading to a moderate to severe respiratory insufficiency. The treatment is based on the infant’s conditions at birth. If the baby is vigorous and cries immediately, routine neonatal care should be administered. If the infant is floppy or lethargic, prompt intubation and direct suction of the trachea are warranted. Intrapartum endotracheal intubation and tracheal suction before the shoulder’s delivery is no longer recommended in case of meconium-stained amniotic fluid (see Chap. 25) [6].
Amnioinfusion
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
James Kerns, Erol Amon, Hung N. Winn
Meconium has been associated with increased perinatal morbidity and mortality, especially due to aspiration of meconium-stained amniotic fluid. Meconium aspiration syndrome, defined as respiratory distress requiring mechanical ventilation in a neonate with meconium aspiration, carries a mortality rate of approximately 25% and accounts for about 2% of all perinatal deaths. The passage of meconium in utero occurs in 8% to 16% of all deliveries; however, meconium aspiration syndrome occurs in only 1% to 3% of all cases of meconium-stained fluid (25). Meconium aspiration may occur before or during labor, or during the process of delivery. When meconium is aspirated into the lower respiratory tract, mechanical obstruction and chemical inflammation may occur.
Care of the baby
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
Babies who have suffered acute or chronic fetal distress may pass meconium. They may also have been stimulated to gasp prior to or during delivery and therefore may inhale meconium. These babies are often stained with meconium, which can also be seen in the nose and mouth. It is imperative that as much meconium should be effectively sucked out of the newborn’s oropharynx, nose and trachea as soon as possible after delivery of the head. This meconium should be removed under direct vision via a laryngoscope. Tracheal intubation should also be performed by one of the team experienced in this technique, and meconium aspirated from the trachea. Positive pressure ventilation should be delayed while meconium is being removed. If the heart rate begins to fall and the baby’s general condition deteriorates, then ventilation should be commenced immediately following aspiration.
Congenital bilateral nasolacrimal duct cysts with respiratory distress in a newborn
Published in Acta Oto-Laryngologica Case Reports, 2022
Haruo Yoshida, Chiharu Kihara, Kyoko Kitaoka, Chisei Satoh, Yoshihiko Kumai
A 0-day-old female infant was born at 40 weeks and 2 days of gestation with oligohydramnios and a low birth weight of 2440 g. The Apgar score was 8 points in both 1 and 5 min, but she exhibited respiratory distress requiring oxygenation immediately after birth. She was then transported to the neonatal intensive care unit in our hospital as an emergency case. Blood examination, blood gas analysis, and chest X-ray were performed. Meconium aspiration syndrome was suspected initially because of elevated blood carbon dioxide levels and pulmonary air leak and partial atelectasis of the left lung. Thus, nasal continuous positive airway pressure (nCPAP) delivery was implemented, and ampicillin was administered intravenously for 4 days. However, resistance was felt during suctioning of both nasal cavities, and large amounts of nasopharyngeal secretions could not be removed; therefore, she was referred to the Department of Otolaryngology at 3 days of age.
The relationship of foetal superior mesenteric artery blood flow and the time to first meconium passage in newborns with late-onset foetal growth restriction
Published in Journal of Obstetrics and Gynaecology, 2022
Melih Velipasaoğlu, Ozge Surmeli Onay, Adviye Cakil Saglık, Ozge Aydemir, Huseyin Mete Tanır, Ayşe Neslihan Tekin
The developmentally programmed meconium passage in newborn infants mostly occurs within the first 24 to 48 h after birth (Ahanya et al. 2005). The time to FMP has been related to race, GA, birth weight, mode of delivery, respiratory distress syndrome and the time to first feeding (Ezomike et al. 2019). The time to FMP has been reported as a good indicator of distal colonic function in newborns (Ezomike et al. 2019). In case of delayed meconium passage, the diseases involving Hirschsprung’s disease (HD), anorectal malformations, intestinal atresia, meconium plug syndrome, meconium ileus, small left colon syndrome, hypothyroidism, sepsis, electrolyte abnormalities (hypercalcemia, hypokalaemia), and maternal medications (magnesium sulphate, illicit drugs) should be investigated (Ezomike et al. 2019). The delayed passage of meconium in preterm infants is a result of immature bowel function which could not completed its development (Ahanya et al. 2005).
Echogenic particles in the amniotic fluid of term low-risk pregnant women: does it have a clinical significance?
Published in Journal of Obstetrics and Gynaecology, 2021
Gul Nihal Buyuk, Z. Asli Oskovi-Kaplan, Serkan Kahyaoglu, Yaprak Engin-Ustun
Term singleton pregnant women (37–42 weeks of gestation) who delivered either vaginally or by caesarean section within 24 h of the ultrasound scan were included in this study. The exclusion criteria were as follows: pregnant women with previous caesarean section or uterine surgery, pregnancies with a non-vertex presentation, pregnancies with indefinite gestational age (absent first-trimester ultrasound or unknown last menstrual period), multiple pregnancies, if delivery was not performed within 24 h of the ultrasound scan, high-risk pregnancies (preeclampsia, intrauterine growth restriction, preterm delivery) and pregnancies complicated by a systemic disease (thrombophilia, hypertension, diabetes, etc.). Clinical characteristics of the patients, amniotic fluid characteristics on ultrasound (anechoic or echogenic), obstetrical results, and the characteristic of the amniotic fluid following the artificial or spontaneous rupture of membranes (clear/vernix/meconium-stained) were recorded. Gestational age was determined due to crown-rump length in the first-trimester ultrasound, if available. In cases when early ultrasound data were not available, gestational age was calculated according to the first day of the last menstrual period. The study group was formed of pregnant women with dense intra-amniotic free-floating particles in a 1–5 mm linear size (Figure 1). Upon inspection of the amniotic fluid following the rupture of membranes, vernix caseosa was considered when white and thick particles were detected. The fluid was considered meconium-stained when greenish, yellow-green, or brown-green particles were present.