Perinatal Education Programme - Care of infants at birth

Management of the meconium stained infant

36-52 DOES THE MECONIUM STAINED INFANT NEED SPECIAL CARE?

Yes. All infants that are meconium stained at birth need special care to prevent severe meconium aspiration. Whenever possible, all these at-risk infants should be identified before delivery by noting that the liquor is meconium stained.

36-53 WHY DOES THE MECONIUM STAINED INFANT NEED SPECIAL CARE?

As a result of fetal hypoxia before delivery, the fetus may make gasping movements and pass meconium. Before delivery, meconium in the amniotic fluid can be sucked into the upper airways. Fortunately most of the meconium is unable to reach the fluid filled lungs of the fetus. Only after delivery, when the infant inhales air, does meconium usually enter the lungs.
Meconium contains enzymes from the fetal pancreas that can cause severe lung damage and even death if inhaled into the lungs at delivery. Meconium also obstructs the airways. Meconium aspiration results in respiratory distress after delivery.
Meconium often burns the infant's skin and digests away the infant's eye lashes! Therefore, imagine the damage meconium can cause to the delicate lining of the lungs.

36-54 HOW CAN YOU PREVENT MECONIUM ASPIRATION AT DELIVERY?

Before delivery of all meconium stained infants, a suction apparatus and an F 10 end hole catheter must be ready at the bedside. If possible, the person conducting the delivery should have an assistant to suction the infant's mouth when the head delivers.
After delivery of the head, the shoulders should be held back and the mother asked to breathe fast and not to push. This should prevent delivery of the trunk. The infant's face is then turned to the side so that the mouth and throat can be well suctioned. The nose can be suctioned after the mouth and throat. The infant should be completely delivered only when no more meconium can be cleared from the mouth and throat.
If the infant cries well after delivery, no further resuscitation or suctioning is needed. However, some infants develop apnoea and bradycardia as a result fetal hypoxia of the suctioning and, therefore, need ventilation after delivery. If a meconium stained infant needs ventilation, the throat should again be suctioned before ventilation is started.
This aggressive method of suctioning is very successful in preventing severe meconium aspiration in meconium stained infants.

When a meconium stained infant is delivered by caesarean section, the mouth and throat must similarly be suctioned with a F10 end-hole catheter, BEFORE the shoulders are delivered from the uterus. After complete delivery, move the infant immediately to the resuscitation table. If the infant does not breathe well, further suctioning is needed before stimulating respiration or starting ventilation.

36-55 WHAT CARE SHOULD YOU GIVE TO MECONIUM STAINED INFANTS AFTER BIRTH?

All meconium stained infants should be observed for a few hours after delivery as they may show signs of meconium aspiration. Most meconium stained infants have also swallowed meconium before delivery. Meconium is a very irritant substance and causes meconium gastritis. This results in repeated vomits of meconium stained mucus.
Meconium gastritis may be prevented by washing out the stomach with 2% sodium bicarbonate (mix 4% sodium bicarbonate with an equal volume of sterile water). Five ml of 2% sodium bicarbonate is repeatedly injected into the stomach via a nasogastric tube and then aspirated until the gastric aspirate is clear. This should be followed by a feed of colostrum. Only heavily meconium stained infants should have a stomach washout on arrival in the nursery. Routine stomach washouts in infants with mildly meconium stained liquor are not needed.

Text prepared by Dave Woods

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Edited by Aldo Campana,