In modern medicine, the term meconium aspiration refers to the so-called respiratory distress syndrome in newborns. Respiratory distress syndrome appears immediately after the birth of the newborn and is always due to impaired lung function.
What is meconium aspiration?
In approximately 10 to 15 percent of all recorded births, a condition called meconium aspiration occurs. Since the newborn’s lungs cannot fully develop, especially in the context of premature birth, a so-called respiratory distress syndrome occurs. Already in the amniotic fluid, the unborn come into contact with the individual meconium particles. It is not uncommon for newborns to be born unconscious as a result. This condition requires immediate resuscitation. In most cases, however, the so-called respiratory distress syndrome only appears after several hours. If an infection occurs in the course of meconium aspiration, there is an acute danger to the newborn’s life. Often, the said infection develops into pneumonia, which in the worst case can lead to death.
Causes
For the occurrence of a so-called meconium aspiration, the so-called meconium particles are significantly responsible. With the term meconium, medical professionals usually refer to the first stool of unborn babies. As early as the sixteenth week of pregnancy, feces can pass into the amniotic fluid. Often, transfer of feces into the amniotic fluid occurs in the context of a stressful situation. As a result of this process, the amniotic fluid usually turns green. If meconium aspiration is suspected, a comprehensive examination must be initiated.
Symptoms, complaints, and signs
Meconium aspiration is a medical emergency characterized by severe respiratory problems, cyanosis, and possibly symptoms of shock. The newborn infant appears floppy because there is no muscle tone or severely decreased muscle tone. The infant’s breathing is barely perceptible. It does not cry like normal newborns, but only whimpers. Retractions are observed on the diaphragm, jugulum, and intercostal spaces. Skin and mucous membranes are blue in color due to lack of oxygen. The amniotic fluid is green in color at birth because it contains meconium. The baby’s skin is visibly smeared with meconium. Meconium is found in folds of skin, in the ears, inside the nasal passages, and in the mouth and throat. Often, the skin, umbilical cord, and nails are stained green, indicating that meconium has been shed for some time. However, the meconium discharge may have occurred just before birth. The severity of the cardiovascular problems depends on the duration and severity of the respiratory distress. In particularly severe cases, the child is born already unconscious due to a significant prenatal oxygen deficiency. Immediate resuscitation is then required. A valvular effect of the meconium causes overinflation of the lungs and a pneumothorax. Overdistended alveoli may rupture, with air then entering the pulmonary connective tissue, forming interstitial emphysema. This, along with the possible development of pneumonia due to meconium accumulation in the airways, often creates an acutely life-threatening situation for the newborn.
Diagnosis and course
The diagnosis of so-called meconium aspiration is made during an initial clinical examination of the child. During this examination, among other things, the child’s glottis is examined. If green water is found behind the glottis, physicians speak of meconium aspiration. To confirm the initial suspicion of meconium aspiration, a chest x-ray is considered. An application of the imaging technique can reveal suspicious shadows on the lungs. In most cases, the shading is limited to a specific area of the lung. However, if the shading affects the entire lung, modern medicine refers to it as white lung. In this case, any pneumonia that may be present can no longer be clearly identified. To avoid possible late consequences, meconium aspiration requires immediate and extensive therapy.
Complications
Because of meconium aspiration, neonates suffer from various complaints.Without treatment of these symptoms, the child may die in the worst case. As a rule, the child shows no signs of life or ordinary breathing immediately after birth. The skin and fingernails also turn blue due to the breathing difficulties. The children are also unable to cry, but only whimper and appear very weak and listless. Usually, meconium aspiration requires immediate treatment by a physician to prevent the patient’s death or further sequelae in adulthood. Especially the parents or the relatives of the child may suffer from severe psychological discomfort or depression and anxiety due to the symptoms of meconium aspiration. The treatment itself is carried out with the help of a surgical intervention. This usually leads to success, with complications rarely occurring. The patient may be dependent on artificial respiration. Psychological discomfort of parents and relatives must also be treated, although in most cases there is a positive course of the disease.
When should one go to the doctor?
In the event of respiratory distress in the newborn infant, emergency medical care must be initiated immediately to prevent the infant’s sudden demise. In an inpatient birth, attending nurses and physicians provide initial care for the infant. They notice any discrepancies immediately during the birth process and independently initiate the necessary steps to ensure adequate oxygen supply. If the birth takes place in a birth center or if a home birth is performed, the midwife or other obstetricians notice the breathing disorder. They also independently initiate the necessary steps for adequate care of the newborn without further prompting. In addition, an emergency medical service must be alerted and first aid measures must be taken. Parents should follow the instructions of nursing and care personnel and comply with their requests for action. In the event of a sudden and unplanned birth, an emergency physician must be called as soon as possible by the mother or other persons present. Until the ambulance arrives, the child’s oxygen supply must be ensured by mouth-to-mouth resuscitation. Often the child is born unconscious. Therefore, there is an acute need for action and emergency care is required. If the skin is blue, there is cause for concern. Respiratory activity must be checked immediately.
Treatment and therapy
Meconium aspiration is always treated in a so-called perinatal center. In addition to the technical equipment, the staffing in a perinatal center is especially designed for the therapy of meconium aspiration. Depending on the severity, so-called CPAP ventilation via the nose is initiated. Within the scope of this therapy method, the newborn is supported in the phase of exhalation by actively applying pressure. If the respiratory distress syndrome is severe, endotracheal intubation in conjunction with mechanical ventilation is considered. Mechanical ventilation intervenes in a supportive manner in both the inhalation and exhalation phases. All the above-mentioned measures always require so-called pulse oximetry. In addition to the oxygen saturation of the blood, the so-called pulse oximetry primarily monitors the heart rate of the child. Simultaneous monitoring of blood pressure is essential here.
Outlook and prognosis
If left untreated, meconium aspiration inevitably leads to premature demise of the affected individual. The infant’s respiratory supply is restricted, triggering death. First aid measures must be applied to ensure a chance of survival. If the course of the disease is unfavorable, a life-threatening condition may develop even after the acute period, resulting in premature death. There is an increased risk of developing pneumonia. This must be medically managed, especially in newborns, to ensure survival. Artificial respiration is mandatory for this condition. Otherwise, death occurs within a few minutes. Therefore, the general health of the child is crucial for a prognosis. It is improved if there are no other health restrictions.Likewise, it must be ensured that adequate medical care is provided within a few minutes. A spontaneous birth without the presence of obstetricians is given an unfavorable prognosis. Newborns who see the light of day in an inpatient setting have the best chance of survival. Once the acute phase is overcome and pneumonia does not develop, the further course is positive. Within a short period of time, there is a significant alleviation of symptoms as well as recovery. Nevertheless, the infant’s cardiovascular system must be monitored for a longer period of time.
Prevention
Meconium aspiration cannot, in principle, be actively prevented. However, the respiratory distress syndrome that results can be treated preventively, especially in the event of a possible preterm birth. If a premature birth is expected, physicians consider administering betamethasone. The administration of this special preparation is intended to actively support the lung maturation of the unborn child. In addition to betamethasone, the drug tocolysis is also used. By administering tocolysis, the time of birth can be postponed in most cases. The time gained should actively contribute to the maturation process of the lungs. In addition, comprehensive perinatal care and gentle induction of the upcoming birth can noticeably reduce the risk for the occurrence of respiratory distress syndrome.
Follow-up care
Meconium aspiration can lead to a number of different symptoms or complications, although these are highly dependent on the exact cause and also the severity of the condition. Because treatment is relatively complex and lengthy, follow-up care also focuses on good management of the condition. Sufferers should try to focus on a positive healing process despite the adversities. To build the appropriate mindset, relaxation exercises and meditation can help calm and focus the mind. This is fundamental to recovery and helps to cope more easily with the stresses and strains. Suddenly occurring complaints should be clarified immediately with the doctor. Provided that recovery has largely taken place, value should basically be placed on a healthy lifestyle that avoids stress, provides for plenty of sleep, as well as a balanced diet to strengthen the immune system.
What you can do yourself
After the initial therapy of meconium aspiration, parents can take various measures to support the healing process and avoid any subsequent symptoms. Initially, it is important to monitor the newborn well. If any unusual symptoms appear, the family doctor must be contacted, who will perform a further examination if necessary and prescribe a suitable medication for the child. Affected children are usually also physically weak, so stress and exertion should be avoided. Despite all measures, the child may be prone to asthma later in life. Parents should learn about the respiratory disease early and take preparatory measures. An asthma inhaler and other medications are best organized as a preventive measure so that they can then react quickly in the event of a possible first attack. If serious complications occur later in the course, intensive medical treatment is indicated. If the course is severe, parents may need therapeutic support. Self-help groups are a good way to talk to other affected parents and share experiences. The parents can find out exactly which measures are sensible and necessary by talking to the doctor in charge and a therapist.
