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Meconium aspiration syndrome and extracorporeal membrane oxygenation
  1. P J DAVIS
  1. Heartlink ECMO Centre, Glenfield Hospital, Leicester, UK
  2. Cardiac Intensive Care Unit, Great Ormond Street Hospital, London, UK

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Meconium aspiration syndrome (MAS) is a common cause of lung disease in neonates. Meconium staining of amniotic fluid occurs in around 10% of all deliveries at term. Asphyxia before birth stimulates intestinal peristalsis and relaxation of the anal sphincter, and in more severe cases, gasping in utero, leading to meconium aspiration. Respiration after birth draws meconium firstly into the major airways and subsequently into the smaller airways, where it may cause obstruction, atelectasis, air trapping, and pneumothorax. Meconium can also cause a chemical pneumonitis and inactivation of surfactant, further impairing gas exchange and potentiating barotrauma. Infants with severe MAS rapidly develop pulmonary hypertension with right to left shunting through a patent foramen ovale and at the level of the arterial duct; this shunting further potentiates hypoxia. Severe MAS occurs in around 1 in 500 births,1 and is characterised by profound hypoxaemia, where the coexistence of parenchymal lung damage and severe pulmonary hypertension can result in a vicious cycle of clinical decline, which is often simply exacerbated by the necessary escalation of “conventional” treatment.

Key messages

Infants with severe MAS are relatively “ideal” candidates for ECMO in that:

  • almost all are > 34 weeks gestation and weigh > 2 kg (cut off for ECMO)

  • they have a potentially reversible respiratory problem

  • associated pulmonary hypertension, although severe, is almost always reversible

  • these infants need the “lung rest” that ECMO provides

  • ECMO is an effective form of treatment for infants meeting the criteria

  • as a subgroup, patients with MAS have a very favourable outcome

As the field of perinatology has advanced, much attention has been focused on the prevention of MAS, with emphasis on timely delivery and skilled neonatal resuscitation. In infants born with meconium staining of the liquor, the oropharynx should be suctioned before they take their first breath, preferably while …

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