During a severe blizzard, a 25 year-old Caucasian woman named Linda arrives at Thomas Jefferson University Hospital in Philadelphia, PA after being in labor for over thirty hours at home. Being only 28 weeks pregnant, she was hoping that her contractions would be able to be stopped. Unfortunately the delivery was not able to be interrupted and she delivered a premature baby boy named David at 28 weeks gestation; weighing only 1400 grams. Due to the difficult labor, and baby David being a Frank breech, David was delivered via caesarian section. Upon delivery, David was assessed and was not making any breathing efforts, had no movement of his limbs, a cyanotic appearance, and was covered with meconium-stained amniotic fluid. Tactile stimulation was applied, but baby David still did not show any breathing efforts and had a heart rate of only seventy-five beats per minute. The APGAR score for his heart rate was a one and for respiratory effort, muscle tone, reflex/irritability, and color, it was a zero (APGAR). David had a score of one out of a possible ten points. Baby David needed to be resuscitated while still in the delivery room.
Premature infants, those under thirty-seven weeks gestation, are the largest proportion of neonates that will require some degree of resuscitation. Being less than thirty-two weeks gestation and weighing less than 1,500 grams only increases the chances that resuscitation will be necessary (Wiswell 289). Baby David has many factors that are not in his favor. Being born via caesarian delivery, through meconium-stained amniotic fluid, having a heart rate of less than one-hundred beats-per-minute, poor muscle tone, and no respiratory effort required intubation and suctioning. This, as well as chest physiotherapy, is what is recommended for babies born in this situation (292).
Baby David not only was born through meconium-stained amniotic fluid, he has aspirated some of the fluid. His condition is known as meconium aspiration syndrome (MAS). Meconium is the green-tinged bowel content of an infant that surprisingly, is sterile. By itself, it is harmless to the fetus. The problem occurs when the infant passes meconium into the amniotic fluid and aspirates it at the time of delivery or during the baby’s first few breaths. It can cause serious airway obstruction, air trapping, enhance growth of bacteria and can compete with surfactant components for absorption to the alveolar surface. It can also break down certain components of the surfactant (Walsh 470). This is a life threatening event that needs to be dealt with immediately.
Meconium aspiration syndrome is much more serious than merely being born in meconium-stained amniotic fluid (MSAF). In a retrospective study, of the neonatal intensive care unit of a tertiary care hospital, the presence of co morbid conditions was studied to compare babies born in meconium-stained amniotic fluid that aspirated fluid (MSAF with MAS) compared to babies born in in...