- Meconium: First stool-if expelled prior to delivery it is present in amniotic fluid
- It is a sign that there has been some fetal distress
- Aspiration: Breathing something into the lungs
- Meconium Aspiration: Meconium that has been released prior to delivery in amniotic fluid is aspirated prior to delivery or with their first breath.
- The presence of meconium can indicate fetal distress but it does not mean that all infants who expel meconium early are in distress
- Especially concerned because not only are we getting gunk in the lungs, it’s feces!
- Immediate respiratory issues
- General respiratory distress
- Abnormal breath sounds
- Increase RR
- Green, yellow amniotic fluid
- Discolored nails, cord, tongue
- Quick intervention/action is essential
- Suction immediately after head is delivered BEFORE first breath
- New guidelines are to stimulate immediately after delivery
- Some facilities might do older practice which is to attempt to intubate and suction the meconium before the infant cries or is stimulated to cry
- ECMO may be necessary in severe cases
- Human Development
- Possibly NICU admission
- Extra team members in the delivery
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In this lesson I will explain meconium aspiration and help you understand the clinical presentation and your role for this patient.
So I first want to explain the terminology so this will be easier to understand for you. Meconium is the first stool and it is described as a black, tar substance that is extremely sticky. If you have ever see this first stool it is so hard to even wipe off their skin, just so so sticky. You can see in this image the meconium stool. Its so thick and sticky, now imagine that in your lungs! Sometimes babies will expel this meconium prior to delivery either because they are postterm or got under some stress. When the fetus gets stressed in utero they sometimes will stool. So now it is present in amniotic fluid. Now sometimes it is just meconium in the fluid and no problem. But sometimes aspiration can occur. So the baby either does practice breaths in utero and gets it in their lungs or they take that first breath at delivery and inhale or aspirate it into the lungs. This is not good There is stool in the lungs and it doesn’t belong there! Now let’s look at our assessment.
What do you think this baby will look like? Well there is going to be Immediate respiratory issues. There is a sticky tar substance on the lungs so that makes it hard to breathe. The babies first breath and cry help pop those lungs open, but if meconium is aspiratored then the meconium keeps those lungs stuck together so they can’t expand and exchange oxygen appropriately. So on assessment we might see cyanosis, grunting, labored breathing or abnormal breath sounds. The amniotic fluid is supposed to be clear but in if meconium is present there will be a green, yellow or light brown color. The babies will also become meconium stained so there will be discolored nails, cord, and sometimes even the tongue on assessment. They just get stained by it.
Our management is going to be quick action. We need to be fast because when meconium aspiration happens it happens fast. So suction needs to happen immediately. Mouth first then nares so you make sure the mouth out before their first big breath. There have been recent practice changes between stimulating verses intubating at delivery so it used to be that at delivery the baby would be born and immediately go to the warmer and be intubated to suck the meconium out if meconium was visualized. Recently new recommendations say to bulb syringe and stimulate like a normal delivery. So this should be the standard of practice now. Antibiotics are necessary because there are feces in the lungs and this baby is so sick so they will be given several antibiotics. ECMO may be necessary in severe cases so that blood flow can bypass the lungs and rest. The family just needs to be educated that there might be a few extra team members at the delivery from NICU and that if aspiration occurs the baby will probably be going to the NICU.One of our labor nurses had her baby with us and the baby meconium aspirated and that baby was so so sick. We almost coded the baby several times and eventually he got sent to another of our sister hospitals for ECMO. He stayed in the NICU for over a month so it can be really bad!
Elimination and oxygenation are our concepts because meconium is elimination and oxygenation because this becomes our biggest problem.
If you remember these key points then you will be all set. Our important points to remember are that meconium is sticky. The baby aspirates in this case and so it goes to the lungs and the lungs “stick” together so there is respiratory distress. This is also an infection concern because there is stool in the lungs where it shouldn’t be so the baby will need a lot of antibiotics.
Make sure you check out the resources attached to this lesson and review your key points. Now, go out and be your best selves today. And, as always, happy nursing.