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Meconium aspiration Pneumonia

Author(s): Fatehi I

Journal: Iranian Journal of Pediatrics
ISSN 2008-2142

Volume: 4;
Issue: 15;
Start page: 267;
Date: 1992;
Original page

Meconium staining of amniotic fluid (MSAF) is a common problem occurring in 11 to 22% of all deliveries. Meconium aspiration Pneumonia (MAP) complicates approximately 2% of these deliveries with a reported mortality rate of as high as 405. Hypoxia in utero provokes a diving reflex, by which blood flow is redistributed toward vital organs, with corresponding decrease in blood flow to gut. Ischemia of the gut results in hyperperistalsis and relaxation of anal sphincter that results passage of meconium. As long as the fetus dose not become acidetic, aspiration does not occur. However, if there is more severe hypoxia, gasping in utero will lead to aspiration of meconium. If meconium is not removed form trachea after delivery, with the onset of respiration it will migrate from the central airways to the periphery of the lung. MAP consist of a triad of a) Meconium stained liquor, b) Presence of meconium in trachea, and c) Radiological changes. In patients with thin meconium staining and a normal fetal heart rate, oro-and naso-pharynx should be suctioned by the obstetrician prior to delivery of the shoulders; visualization of pharynx and intubation will not be necessary. In thick meconium with fetal heart rate abnormality, following suctioning of the oro-and naso-pharynx the infant's pharynx should be suctioned by the pediatrician followed by endotracheal intubation and direct suctioning of the trachea immediately after birth
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