Aspiration of meconium (the neonates first feces) into the lungs.

Typically occur with the first breath or while the neonate is in utero. Thick, sticky, and greenish black substance; may be seen in theamniotic fluid after 34 weeks gestation. Pathophysiology Asphyxia in utero leads to increased fetal peristalsis, relaxation of the anal sphincter, passage of meconium into the amniotic fluid, and reflex gasping of amniotic fluid into the lungs. Neonates with meconium aspiration syndrome (MAS) increase respiratory efforts to create greater negative intrathoractic pressures and improve air flow to the lungs. Hyperinflation, hypoxemia, and academia cause increased peripheral vascular resistance. Right-to-left shunting commonly follows. Meconium creates a ball-valve effect, trapping air in the alveolus and preventing adequate gas exchange.

Chemical pneumonitis results, causing the alveolar walls and interstitial tissues to thicken, again preventing adequate gas exchange. Cardiac efficiency can be compromised from pulmonary hypertension. Causes Commonly related to fetal distress during labor. Advance gestational age (greater than 40 weeks) Difficult delivery Fetal distress Intrauterine hypoxia Maternal diabetes Maternal hypertension Poor intrauterine growth Risk factors for MAS: Assessment Findings Fetal hypoxia as indicated by altered fetal activity and heart rate. Dark greenish staining or streaking of the amniotic fluid noted on rupture of membranes.

Obvious presence of meconium in the amniotic fluid Greenish staining of the neonates skin (if the meconium was passed long before delivery) or placenta. Signs of distress at delivery, such as the neonate appearing limp, an Apgar score below 6, pallor, cyanosis, andrespiratory distress. Coarse crackles when auscultating the neonates lungs. Test Results Arterial blood gas analysis shows hypoxemia and decreased pH. Chest X-ray may show patches or streaks of meconium in the lungs, air trapping, or hyperinflation. Treatment Respiratory assistance via mechanical ventilation Maintenance of a neutral thermal environment Administration of surfactant and an antibiotic Extracorporeal membrane oxygenation (in severe cases). Nursing Interventions

During labor, continuously monitor the fetus for signs and symptoms of distress. Immediately inspect any fluid passed with rupture of the membrane. Assist with immediate endotracheal suctioning before the first breaths, as indicated. Monitor lung status closely, including breath sounds and respiratory rate and character. Frequently assess the neonates vital signs. Administer treatment modalities, such as oxygen and respiratory support as ordered. Institute measures to maintain a neutral thermal environment. Provide the family with emotional support and guidance.