Meconium Aspiration

The passing of meconium whilst still in the womb is a sign of foetal distress and hypoxia. Risk factors for this include:

• Long/difficult delivery

• Late labour

• Maternal DM/HTN, Smoking, or Drugs

• Foetal growth restriction

The 2 main complications that can occur with meconium are Meconium Aspiration Syndrome and Meconium Ileus.

Meconium Aspiration Syndrome

This is when there's respiratory distress in a neonate that's been born through meconium-stained liquor (meconium-stained amniotic fluid). A stressed baby may gasp in the womb or soon after birth, which leads to then inhaling some of the meconium-stained fluid.

Investigations to do include:

• CXR

• Bloods – FBC, CRP

Management is with:

• Supplementary O2

• Surfactants

• Inhaled nitric oxide

Meconium Ileus

In cases where the meconium is thicker than normal, it can get lodged in the bowel, therefore causing obstruction in the neonate. It should always be considered if a neonate fails to pass meconium in first 12-24 hours after birth.

Other signs of this are those of bowel obstruction i.e. abdominal distension and bilious vomiting.

This complication is typically an early indicator of Cystic Fibrosis.

N.B. Is the first sign of cystic fibrosis in 10% to 20% of children with the disease.

It's usually managed with enema to help soften and pass the meconium. If it becomes complicated e.g. twisting or perforation of the bowel, surgery is indicated.