Resuscitation of the Infant Born through Meconium Stained Amniotic Fluid

Meconium staining of the amniotic fluid is a common complication during delivery of term infants, and approximately 5% to 12% of these infants develop meconium aspiration

Table 22-1 Apgar Score

Score*

Sign

0

1

2

Heart rate

Absent

<100 beats/min

>100 beats/min

Respirations

Absent

Irregular and slow

Strong breaths, crying

Muscle tone

Limp

Some flexion

Good flexion, active motion

Reflex irritability to tactile stimulation

No response

Grimace

Cough, sneeze, cry

Color

Blue or pale

Blue extremities, pink body

Completely pink

*Apgar scoring should be completed at 1 and 5 minutes. The normal Apgar score at 5 minutes is 7 or higher. If the 5-minute Apgar is less than 7, continue resuscitative efforts and assign additional scores every 5 minutes for up to 20 minutes after birth. Modified from Kattwinkel J (ed). Textbook of Neonatal Resuscitation. 5th ed. Elk Grove Village, Ill, American Academy of Pediatrics and American Heart Association, 2006.

syndrome (MAS) (Wiswell et al., 2000). Risk factors for meconium staining of the amniotic fluid include maternal hypertension, maternal diabetes, maternal chronic respiratory or cardiovascular disease, maternal heavy smoking, preeclampsia or eclampsia, oligohydramnios, IUGR, poor biophysical profile, and abnormal fetal heart rate patterns (Gelfand et al., 2004). MAS is a life-threatening disease for otherwise healthy term newborns, and appropriate resuscitation of the infant at risk for MAS is important (see later discussion). All infants at risk for MAS and showing respiratory distress or bradycardia after delivery should undergo standard neonatal resuscitation procedures. In the depressed infant, tracheal suctioning to remove visible meconium can decrease the incidence and the severity of MAS (AAP and AHA, 2006). However, when the infant is vigorous at birth—defined as heart rate greater than 100, spontaneous respiration, and spontaneous movements or extremity flexion—routine endotracheal intubation and tracheal suction does not prevent MAS (Wiswell et al., 2000).

KEY TREATMENT

In the vigorous infant, routine endotracheal intubation and tracheal suction do not prevent meconium aspiration syndrome and can harm the infant (Wiswell et al., 2000) (SOR: A).

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