Meconium aspiration syndrome - Revision history

Rossdonaldson1: /* Background */

2023-11-15T17:55:39Z

Background

← Older revision		Revision as of 17:55, 15 November 2023
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	==Background==		==Background==
			[[File:Meconium aspiration syndrome (MAS).png\|thumb\|Image showing release of meconium into amniotic fluid (top), its progress into the mouth middle), and subsequently into the lung (C).]]
	*Presentation ranges from mild respiratory distress to life-threatening respiratory failure		*Presentation ranges from mild respiratory distress to life-threatening respiratory failure
	*Incidence is 2-10% of infants born through MSAF (meconium-stained amniotic fluid)		*Incidence is 2-10% of infants born through MSAF (meconium-stained amniotic fluid)

Rossdonaldson1: /* Evaluation */

2023-11-15T17:39:46Z

Evaluation

← Older revision		Revision as of 17:39, 15 November 2023
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	==Evaluation==		==Evaluation==
			[[File:MekAsp w 1d 1.3.51.0.7.1277489803.56708.9039.46848.34134.21565.59325.jpg\|thumb\|Chest X-ray of neonate with meconium aspiration.]]
	===Workup===		===Workup===
	*[[CXR]]		*[[CXR]]

Rossdonaldson1: /* Background */

2020-07-01T16:56:23Z

Background

← Older revision		Revision as of 16:56, 1 July 2020
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	*Causes hypoxemia and acidosis via airway obstruction, chemical irritation/inflammation, infection, and surfactant inactivation		*Causes hypoxemia and acidosis via airway obstruction, chemical irritation/inflammation, infection, and surfactant inactivation
	*Associated with persistent pulmonary hypertension of the newborn (PPHN)		*Associated with persistent pulmonary hypertension of the newborn (PPHN)

			{{Newborn vital signs}}

	==Clinical Features==		==Clinical Features==

ClaireLewis: /* Diagnosis */

2019-10-06T18:10:55Z

Diagnosis

← Older revision		Revision as of 18:10, 6 October 2019
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	**[[Transient tachypnea of the newborn]] is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)		**[[Transient tachypnea of the newborn]] is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)
	**Delayed transition from fetal circulation symptoms improve more quickly than those of MAS		**Delayed transition from fetal circulation symptoms improve more quickly than those of MAS
	**[[Congenital heart disease\|Congenital cyanotic heart disease]] is differentiated by physical exam ([[~~murmurs~~]], [[hepatomegaly]]), CXR (cardiac size/shape), and echocardiogram (cardiac anatomy and function)		**[[Congenital heart disease\|Congenital cyanotic heart disease]] is differentiated by physical exam ([[murmur]]s, [[hepatomegaly]]), CXR (cardiac size/shape), and echocardiogram (cardiac anatomy and function)

	==Management==		==Management==

ClaireLewis at 18:10, 6 October 2019

2019-10-06T18:10:38Z

← Older revision		Revision as of 18:10, 6 October 2019
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	*Supportive care: see [[newborn resuscitation]]		*Supportive care: see [[newborn resuscitation]]
	**Adequate oxygenation and ventilation		**Adequate oxygenation and ventilation
	***Supplemental oxygen to keep saturation >99% and PaO2 55-90		***Supplemental [[oxygen]] to keep saturation >99% and PaO2 55-90
	***Assisted ventilation with CPAP if FiO2 exceeds 0.4 to 0.5		***Assisted ventilation with [[CPAP]] if FiO2 exceeds 0.4 to 0.5
	***High frequency oscillatory ventilation or ECMO for those who fail conventional mechanical ventilation		***High frequency oscillatory ventilation or ECMO for those who fail conventional mechanical ventilation
	***Goal PaCO2 50-55 mmHg		***Goal PaCO2 50-55 mmHg
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	***Umbilical lines to monitor blood gases and BP		***Umbilical lines to monitor blood gases and BP
	**Correct metabolic abnormalities		**Correct metabolic abnormalities
	*Empiric antibiotics while awaiting culture results (because of difficulty differentiating between pneumonia initially)		*Empiric [[pediatric antibiotics\|antibiotics]] while awaiting culture results (because of difficulty differentiating between pneumonia initially)
	*Surfactant administration for severe disease requiring mechanical ventilation, FiO2>0.5, and mean airway pressure >10-12		*Surfactant administration for severe disease requiring mechanical ventilation, FiO2>0.5, and mean airway pressure >10-12

ClaireLewis at 01:16, 15 September 2019

2019-09-15T01:16:04Z

← Older revision		Revision as of 01:16, 15 September 2019
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	*[[Tachypnea]]		*[[Tachypnea]]
	*Cyanosis		*Cyanosis
	*Accessory muscle use (intercostal/subxiphoid retractions, paradoxical breathing, grunting, nasal flaring)		*[[Shortness of breath (peds)\|Accessory muscle use]] (intercostal/subxiphoid retractions, paradoxical breathing, grunting, nasal flaring)
	*Barrel-shaped chest		*Barrel-shaped chest
	*Rales and rhonchi on lung auscultation		*Rales and rhonchi on lung auscultation
	*Pneumothorax		*[[Pneumothorax]]
	*Pneumomediastinum		*[[Pneumomediastinum]]

	==Differential Diagnosis==		==Differential Diagnosis==
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	===Workup===		===Workup===
	*[[CXR]]		*[[CXR]]
			**Streaky, linear densities
			**Hyperinflated lungs and flattened diaphragm
			**Diffuse patchy opacities (may appear similar to RDS if severe)
	*[[ABG]]		*[[ABG]]
	*~~Echocardiogram~~		*[[Echocardiography]]
	*Blood and sputum cultures		*Blood and sputum cultures

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	**Respiratory distress shortly after birth		**Respiratory distress shortly after birth
	**Characteristic CXR findings		**Characteristic CXR findings
	***Streaky, linear densities
	***Hyperinflated lungs and flattened diaphragm
	***Diffuse patchy opacities (may appear similar to RDS if severe)
	**If intubation required, meconium visualized in trachea		**If intubation required, meconium visualized in trachea
	*Ways to differentiate between other causes of respiratory distress in a neonate:		*Ways to differentiate between other causes of respiratory distress in a neonate:
	**~~TTN~~ is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)		**[[Transient tachypnea of the newborn]] is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)
	**Delayed transition from fetal circulation symptoms improve more quickly than those of MAS		**Delayed transition from fetal circulation symptoms improve more quickly than those of MAS
	**Congenital cyanotic heart disease is differentiated by physical exam (murmurs, hepatomegaly), CXR (cardiac size/shape), and echocardiogram (cardiac anatomy and function)		**[[Congenital heart disease\|Congenital cyanotic heart disease]] is differentiated by physical exam ([[murmurs]], [[hepatomegaly]]), CXR (cardiac size/shape), and echocardiogram (cardiac anatomy and function)

	==Management==		==Management==

ClaireLewis: /* Management */

2019-01-27T00:08:29Z

Management

← Older revision		Revision as of 00:08, 27 January 2019
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	==Management==		==Management==
	*Supportive care		*Supportive care: see [[newborn resuscitation]]
	**Adequate oxygenation and ventilation		**Adequate oxygenation and ventilation
	***Supplemental oxygen to keep saturation >99% and PaO2 55-90		***Supplemental oxygen to keep saturation >99% and PaO2 55-90

ClaireLewis: /* Clinical Features */

2019-01-27T00:07:43Z

Clinical Features

← Older revision		Revision as of 00:07, 27 January 2019
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	==Clinical Features==		==Clinical Features==
	*Tachypnea		*Usually develop symptoms within 15 minutes after birth
			*[[Tachypnea]]
	*Cyanosis		*Cyanosis
	*Accessory muscle use (intercostal/subxiphoid retractions, paradoxical breathing, grunting, nasal flaring)		*Accessory muscle use (intercostal/subxiphoid retractions, paradoxical breathing, grunting, nasal flaring)
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	*Pneumothorax		*Pneumothorax
	*Pneumomediastinum		*Pneumomediastinum
	*Usually develop symptoms within 15 minutes after birth

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* Differential Diagnosis */

2017-10-31T13:25:08Z

Differential Diagnosis

← Older revision		Revision as of 13:25, 31 October 2017
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	*[[Pulmonary hypertension]]		*[[Pulmonary hypertension]]
	*[[Congenital heart disease]]		*[[Congenital heart disease]]
	*Respiratory distress syndrome

	{{Newborn DDX}}		{{Newborn DDX}}

Rossdonaldson1: /* Evaluation */

2017-10-31T13:24:27Z

Evaluation

← Older revision		Revision as of 13:24, 31 October 2017
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	==Evaluation==		==Evaluation==
	*Workup		===Workup===
	**CXR		*[[CXR]]
	**ABG		*[[ABG]]
	**Echocardiogram		*Echocardiogram
	**Blood and sputum cultures		*Blood and sputum cultures

			===Diagnosis===
	*Clinical diagnosis based on the following:		*Clinical diagnosis based on the following:
	**Evidence of meconium on infant		**Evidence of meconium on infant
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	***Diffuse patchy opacities (may appear similar to RDS if severe)		***Diffuse patchy opacities (may appear similar to RDS if severe)
	**If intubation required, meconium visualized in trachea		**If intubation required, meconium visualized in trachea

	*Ways to differentiate between other causes of respiratory distress in a neonate:		*Ways to differentiate between other causes of respiratory distress in a neonate:
	**TTN is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)		**TTN is more common in late preterm infants (34-37 weeks) and RDS in preterm infants, whereas MAS more common in postmature infants (>41 weeks)