Meconium Aspiration Syndrome

Gestational diabetes is a pregnancy-induced blood sugar disorder that affects as many as 9.2% of all pregnancies. The disorder usually presents itself in the third trimester, when babies begin to grow at a faster rate.  During pregnancy, the placenta produces hormones that can affect the body’s ability to process glucose. These hormones are vital for the development of a child in utero, but may simultaneously (and detrimentally) cause insulin resistance, which increases the mother’s blood sugar levels and can lead to gestational diabetes.

Typical signs that an infant has suffered MAS include bluish skin color, breathing problems or total absence of breathing, dark green or brownish staining of the amniotic fluid, and limpness in the infant at birth. Other signs include meconium staining on the vocal cords as observed with a medical instrument called a laryngoscope. In addition, coarse and crackly breathing and a chest x-ray that shows patchy or streaky areas on the lungs often confirms the presence of meconium aspiration. Testing the baby’s blood after delivery can determine whether MAS has resulted from a lack of oxygen. Low APGAR scores can also be an indication of MAS.

Physicians may notice signs of MAS hours before birth and take steps to protect the newborn. Green or brown tinged amniotic fluid indicates that the baby has had a bowel movement while still in the uterus. A slow heart rate on the fetal heart monitor or other abnormalities can be indicative of MAS, as the passage of meconium while inside the uterus can be a result of stress due to lack of blood and/or oxygen. Other risk factors that may cause stress and lead to MAS include a pregnancy that goes far past the due date, gestational diabetes, high blood pressure of the mother during the pregnancy, and a difficult delivery or long labor.

Treatment for MAS may include inserting a tube into the infant’s windpipe to suction out any meconium, giving antibiotics to treat any infection, tapping on the newborn’s chest to loosen meconium secretions, and placing the newborn on a respirator to alleviate breathing problems or a warmer to maintain body temperature. Other interventions include administering an oxygen mask to inflate the baby’s lungs or admission to the special care nursery or newborn intensive care unit. In more severe cases of MAS, the newborn may require surfactant (a substance found in the lungs that helps us inhale and exhale), nitric oxide to help blood flow and oxygen exchange in the lungs, or extracorporeal membrane oxygenation, or ECMO, which is a type of heart/lung bypass. Inadequate or improper removal of meconium from the airway prior to an infant’s first breath increases the likelihood of MAS.

Though most cases of MAS resolve quickly without many side-effects, more severe cases result in breathing problems, including rapid breathing that may persist for days. A newborn with severe MAS and can suffer brain damage, permanent lung damage, cerebral palsy, seizures, mental retardation, central nervous system issues, and even death. Severely affected infants also have a 50% risk of developing reactive airway disease (narrowing of the airways) in the first six months of life.