Meconium is the sterile substance that is produced in the baby’s intestines during gestation and is normally passed like stool for the first few days after birth. When meconium is passed in utero and mixed with amniotic fluid, the baby may inhale, or aspirate, the meconium-stained fluid. Meconium does not usually develop before 34 weeks gestation, so this is usually found in babies born at term. The aspiration of meconium can occur before or during labor and immediately after delivery. This thick meconium can irritate and block baby’s airway.
Physiologic stress on the baby is the normal cause for the passage of meconium in utero. This stress can be caused by maternal hypertension, decreased amount of amniotic fluid, maternal infection, insufficient placenta, fetal hypoxia due to the umbilical cord being wrapped around the neck, or maternal drug use.
Patient will maintain adequate breathing with respiratory rate and oxygen saturation within normal range
Assess respiratory status
Meconium aspiration can result in varying degrees of respiratory distress for the infant
Bulb suction mouth and nose or use endotracheal suction to remove secretions
Administer oxygen via hood or positive pressure
Maintain oxygen saturation at 90-95%. Mechanical ventilation may be necessary.
Assist with insertion of umbilical artery catheter
An umbilical artery catheter will minimize agitation and stress of frequent monitoring of blood pH and blood gases by giving direct access to the umbilical artery.
Administer surfactant therapy and medications as necessary
Monitor hemoglobin levels
Hemoglobin level is an indicator of effective oxygen carrying capacity
Monitor blood pressure
Worsening blood pressure may indicate pulmonary hypertension or pulmonary air leak syndrome
Monitor for signs of Acute Respiratory Distress Syndrome (Arterial Blood Gases)
Fluid and meconium in the lungs can initiate an inflammatory process that can lead to severe respiratory distress, requiring mechanical ventilation and other invasive interventions for the newborn.
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