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Meconium Aspiration – Treatment

The severity of complications and negative effects of meconium aspiration usually depends on the amount and thickness of it in a fetus or baby’s system; the treatments options also vary according to the amounts and thickness that was aspirated and, therefore, the severity of the problems caused by the meconium.

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Before delivery, if there are traces of meconium in the amniotic fluid that is released when the mother’s water breaks, doctors may try to thin the amount in the amniotic fluid or take measures to prevent aspiration. Specifically, during labor doctors may utilize a method called “amnioinfusion.” This procedure is meant to dilute the amount in the amniotic fluid by inserting sterile fluid in the uterus. Note, however, that certain studies have questioned the benefits of amnioinfusion to reduce the risk of severe meconium aspiration syndrome, and so you should discuss this procedure and any other with your doctor.

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If meconium is detected in the amniotic fluid released when the mother’s water breaks, doctors may take extra care to ensure that the fetus is under a minimum amount of distress possible during labor and delivery. This is done as an attempt to minimize the amount of meconium that finds its way into the fetus’s respiratory system.

When meconium is detected in amniotic fluid upon delivery, many doctors will first suction any traces of meconium from an infant’s respiratory system, including the baby’s nose, mouth, and throat. They may also place a tube down the infant’s trachea to suction any meconium out. Again, please note that most recent neonatal best practices guidelines no longer recommend suctioning the mouth, nose, and throat for infants who were born with meconium present in their amniotic fluid, as this suctioning comes with its potential risks. Such suctioning is especially not recommended for babies who are active and crying (not depressed) as the chances of aspiration and complications that could arise to the level of a meconium aspiration syndrome diagnosis are slight. Instead, if a baby is not crying and active, is depressed, and seems to have trouble breathing, it is now recommended that suctioning be limited to placing a tube down the infant’s trachea and applying a brief amount of suctioning as the tube is pulled out. This process can be repeated until the suctioned fluid contains no traces of meconium.

Also, if a baby is having respiratory trouble, is not breathing, or has a low heart rate, the baby’s medical team will try to help facilitate the baby’s breathing and increase the amount of oxygen in the infant’s system. Typically, oxygen is delivered through the use of a “hood” or a mask with an oxygen bag attached.

Alternatively, and in cases where an infant continues to have respiratory difficulties, the infant may be “intubated,” or, placed on a ventilator. The use of a ventilator may be used in conjunction with continuous positive airway pressure (CPAP) treatment. If the infant’s breathing problems are severe, the doctor may order “extracorporeal membrane oxygenation” treatment (or “ECMO”). ECMO entails hooking up the infant to a machine “lung” that does the baby’s breathing for it – potentially allowing the baby’s heart and lungs to rest and heal from the meconium exposure and side effects. Note that ECMO can carry risks of neurological complications, and therefore doctors use it very sparingly and when other options prove ineffective. In these cases, the infant will likely be placed in special care or the newborn intensive care unit for monitoring.

Depending on the problems the meconium aspiration has triggered, doctors may give the infant surfactant treatment. Meconium depresses the activation of surfactant – a substance that lines the lungs and helps respiratory functioning -- in an infant’s lungs. As such, studies have found that the ingestion of additional surfactant can, therefore, help the infant’s breathing and decreases the risk of more severe respiratory failure.

If an infant is showing signs of persistent pulmonary hypertension of the newborn (PPHN) due to meconium aspiration, certain specific treatments have shown to be effective. PPHN is when an infant’s body does not transition to normal circulation (in which most blood goes through the lungs) after delivery but maintains fetal circulation, in which much of the blood skips the lungs. This impeded circulation can lead to a lack of oxygen in the brain and other organs and cause serious immediate and long-term issues if untreated. Studies have shown that inhaled nitric oxide (iNO) treatment has been very effective in treating PPHN, as the nitric oxide helps open up the blood vessels in the lungs, promoting blood flow and oxygen exchange.

Other typical treatments include the use of antibiotics. Even in mild cases of meconium inhalation doctors will often administer broad-spectrum antibiotics, as the presence and side effects can weaken the infant’s immune system and put it at risk of infection. Moreover, any invasive procedures can also put the baby at risk of infection. If the baby is asymptomatic of any infections and further meconium aspiration syndrome symptoms, antibiotics are usually stopped after 48 hours. If blood work shows signs of potential infection, antibiotics may be continued for up to 7 days. Note, however, that the use of antibiotics to treat mild cases of meconium aspiration is currently being debated, with some experts only recommending such broad antibiotic use for more serious cases. Doctors may also place the infant on a radiant warmer to keep the infant’s body temperature up while the body is dealing with and recovering from the effects of the meconium.

As noted above concerning many of the different treatments for the varying levels and complications arising from meconium aspiration, new information about the efficacy of particular treatments continues to emerge, and there is continuing debate about best practices. As such, it is recommended that you discuss treatment closely with your doctors, and, if you feel it is necessary, ask for a second opinion to ensure your primary doctor’s recommendation is in line with the latest studies and data.