![]() Meconium is the name given to the first poop a baby has. Meconium staining may not only be ‘not scary’ for almost every birth, but it is actually quite normal for babies born between 37-42 weeks gestation! The 2015 AHA/AAP guidelines emphasize on following the same resuscitation steps for infants with a meconium-stained amniotic fluid similar to those infants with clear fluid.Current research disproves the need of immediate alarm that occurs when meconium is found in the amniotic fluid. Airway clearance with suctioning of the meconium is recommended if the airway is obstructed. Interventions such as endotracheal intubation for positive pressure ventilation may be required in severe instances, and a prompt transfer to the neonatal intensive care unit for further management may be needed. The 2015 AHA/AAP guidelines do not recommend this practice and rather recommend immediate appropriate management to support ventilation and oxygenation, such as commencing positive pressure ventilation. If the infant is not vigorous with poor neurological tone, insufficient breathing efforts, and bradycardia (heart rate <100 beats/minute), routine postnatal suctioning of the airways was widely practiced in the past to decrease the possibility of development of meconium aspiration syndrome. ![]() Close monitoring in the newborn nursery is warranted. However, if the airway is obstructed, then the airway clearance with suctioning of the meconium is recommended. Routine suctioning of the meconium-stained fluid from the oropharynx is not recommended in these infants. If the infant is vigorous with good muscle tone and respiratory efforts, further newborn care could be provided in the delivery room. In the updated 2015 American Heart Association/American Academy of Pediatrics guidelines (AHA/AAP), routine intrapartum suctioning of the airways before the delivery of the shoulders is not recommended. Latest guidelines recommend changing these practices quoting that these procedures are of unknown benefit and may be even harmful. Traditionally, during labor, if meconium-stained amniotic fluid is encountered, an intrapartum suctioning of airways was done. During delivery, if meconium-stained amniotic fluid is noted, a neonatal resuscitation team should be promptly involved. ![]() Because the fetus swallows amniotic fluid in utero, meconium can be present in the infant's oropharynx at delivery. Brown or green staining of the fluid indicates the passage of meconium. Amniotic fluid should be clear, or straw tinged with small vernix particles in the fluid. In the event of the rupture of the fetal membranes, the nurse should assess the color of the amniotic fluid. Nursing, Allied Health, and Interprofessional Team Interventions In-utero passage of meconium before 32 weeks of gestation is rare, and in preterm babies, meconium-stained amniotic fluid may indicate chorioamnionitis, fetal sepsis (e.g., listeriosis) or in-utero cord compression. Similarly, induction of labor is to be considered between 41- 42 weeks of gestation. To reduce the risk of adverse consequences related to meconium-stained amniotic fluid, the American College of Obstetricians and Gynecologists 2014 guidelines recommend induction of labor at or after 42 weeks. This complication happens in about 3-9% of the babies delivered with meconium-stained amniotic fluid. The accidental inhalation of meconium in-utero or during delivery can result in an adverse event for the infant, which is known as meconium aspiration syndrome. Babies born through a meconium-stained amniotic fluid are at higher risk of development of adverse events such as perinatal asphyxia and respiratory distress. Some of the conditions associated with meconium passage in-utero include placental insufficiency, preeclampsia, oligohydramnios, peripartum infections, and certain maternal drugs such as cocaine. In-utero passage of meconium may indicate normal gastrointestinal maturation or more concerningly it may be a sign of acute or chronic fetal hypoxia. The presence of meconium-stained amniotic fluid is about 12-20% of deliveries and is much higher in post-dated births (up to 40%).
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