3. Fetal Aspiration Syndrome
• Also called aspiration pneumonia
• During prolonged labour and difficult deliveries,
infants often initiate vigorous respiratory
movements in utero because of interference with
the supply of oxygen through the placenta
• Under such circumstances, the infant may
aspirate amniotic fluid
• The amniotic fluid may contain vernix caseosa,
epithelial cells, meconium, blood, or material
from the birth canal
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4. Fetal Aspiration Syndrome
• This may block the smallest
airways and interfere with
alveolar exchange of oxygen and
carbon dioxide
• Pathogenic bacteria may
accompany the aspirated
material, and congenital
pneumonia may ensue
• Even in noninfected cases,
respiratory distress accompanied
by CXR evidence of aspiration is
seen
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5. Fetal Aspiration Syndrome
• Postnatal pulmonary aspiration may also occur in
newborn infants as a result of:
- Tracheoesophageal fistula (TOF)
- Oesophageal and duodenal obstruction
- Gastroesophageal reflux
- Improper feeding practices, and
- Administration of depressant medicines
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6. Fetal Aspiration Syndrome
• To avoid aspiration of gastric contents, the stomach
should be aspirated using a soft catheter just before
surgery or other major procedures that require
anaesthesia or conscious sedation
• If aspiration is sudden and overwhelming, immediate
laryngoscopy and suctioning under direct
visualization may prevent the aspirated material from
reaching the lungs
• The treatment of aspiration pneumonia is
symptomatic and may include respiratory support
and systemic antibiotics
• Gradual improvement generally occurs over 3–4 days
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8. Meconium Aspiration Syndrome
• Meconium-stained amniotic fluid usually occurs
in term or post-term infants
• This is due to placental insufficiency which cause
fetal distress due to hypoxaemia
• Usually, but not invariably, fetal distress and
hypoxia occur before the passage of meconium
into amniotic fluid
• These infants are meconium stained and may be
depressed and require resuscitation at birth
• Meconium inactivates surfactant
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10. Clinical Manifestations
• Either in utero or more often with the 1st breath,
thick, particulate meconium is aspirated into the
lungs
• The resulting small airway obstruction may
produce respiratory distress within the 1st hours
• This manifests with tachypnea, retractions,
grunting, and cyanosis observed in severely affected
infants
• Partial obstruction of some airways may lead to
pneumothorax or pneumomediastinum, or both
• Prompt treatment may delay the onset of
respiratory distress
• Over-distention of the chest may be prominent
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11. Clinical Manifestations
• The condition usually improves within 72 hr (3 days)
• When its course requires assisted ventilation, it may
be severe with a high risk for mortality
• Tachypnea may persist for many days or even several
weeks
• The typical chest roentgenogram (CXR) is
characterized by:
- Patchy infiltrates
- Coarse streaking of both lung fields
- Increased anteroposterior diameter
- Flattening of the diaphragm
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12. Clinical Manifestations
• Severe meconium aspiration may be
complicated by persistent pulmonary
hypertension of the newborn (PPHN)
• Arterial PO2 may be low in either disease and, if
hypoxia has occurred, metabolic acidosis is
usually present
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13. Prevention
• Rapid identification of fetal distress and initiating
prompt delivery
• Nasopharyngeal suctioning after delivery of the
head was once considered a low-risk method of
reducing the incidence of MAS
• Routine intrapartum nasopharyngeal suctioning
does not reduce the risk for MAS
• On rare occasions, it may cause nasopharyngeal
trauma or cause a cardiac arrhythmia
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14. Treatment
• Routine intubation is not recommended
• Depressed infants should undergo endotracheal
intubation, and suction should be applied directly
to the endotracheal tube to remove meconium
from the airway
• The risk is less with laryngoscopy and
endotracheal intubation
• Risks for laryngoscospy and endotracheal
intubation are bradycardia, laryngospasm,
hypoxia, posterior pharyngeal laceration with
pseudodiverticulum formation
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15. Treatment
• Includes supportive care and standard
management for respiratory distress
• The beneficial effect of mean airway pressure on
oxygenation must be weighed against the risk of
pneumothorax
• Patients who are refractory to conventional
mechanical ventilation may benefit from:
- High-frequency therapy (HFT)
- Inhaled nitric oxide (iNO)
- Extracorporeal membrane oxygenation (ECMO)
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17. Prognosis
• The mortality rate is higher than that of non-
meconium stained infants
• Improvements in obstetric and neonatal care has
lead to reduced neonatal deaths
• Residual lung problems are rare: symptomatic
cough, wheezing, and persistent hyperinflation for
up to 5–10 yr
• Ultimate prognosis depends on the extent of CNS
injury from asphyxia and the presence of
associated problems such as pulmonary
hypertension
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