Meconium Aspiration Syndrome – The Core Concept of Pathophysiology during Resuscitation
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Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of MAS. Most aspiration of meconium probably occurs before birth. Following aspiration, meconium may migrate to the peripheral airway, usually take about 2 hours as demonstrated in animal experiment, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diagnosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the management of MAS. Recent studies suggest that avoidance of post-term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso-and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction at birth is considered a controversial procedure and only reserved for infants who have severe retraction at birth suggesting an upper airway obstruction. High frequency oscillatory ventilation with nitric oxide or surfactant may improve mortality. Mortality of MAS has improved; the causes of death are related primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.
Abstract
Aspiration of meconium produces a syndrome (Meconium Aspiration Syndrome MAS) characterized by hypoxia, hypercapnia, and acidosis. Perinatal hypoxia, acute airway obstruction, pulmonary inflammation, pulmonary vasoconstriction, pulmonary hypertension, and surfactant inactivation all play a role in the pathogenesis of MAS. Most aspiration of meconium probably occurs before birth. Following aspiration, meconium may migrate to the peripheral airway, usually take about 2 hours as demonstrated in animal experiment, leading to airway obstruction and subsequent lung inflammation and pulmonary hypertension. The presence of meconium in the endotracheal aspirate automatically establishes the diagnosis of MAS. Clinical diagnosis can be made in any infant born with meconium staining of amniotic fluid who develops respiratory distress at or shortly after birth and has positive radiographic findings. Prevention of intrauterine hypoxia, early cleaning (suctioning) of the airway, and prevention and treatment of pulmonary hypertension are essential in the management of MAS. Recent studies suggest that avoidance of post-term delivery may reduce the risk of intrauterine hypoxia and the incidence of MAS. Routine intrapartum naso-and oropharyngeal suction does not appear to affect the incidence and outcome of MAS. Endotracheal suction at birth is considered a controversial procedure and only reserved for infants who have severe retraction at birth suggesting an upper airway obstruction. High frequency oscillatory ventilation with nitric oxide or surfactant may improve mortality. Mortality of MAS has improved; the causes of death are related primarily to hypoxic respiratory failure associated with irreversible pulmonary hypertension. Morbidity is affected mostly by perinatal hypoxia.
참고문헌 (38)
- Vidyasagar D, "Assisted ventilation in infants with meconium aspiration syndrome", Pediatrics, 56, pp.208~213 (1975)
- Wiswell TE, "Meconium staining and the meconium aspiration syndrome. Unresolved issues", Pediatr Clin North Am, 40, pp.955~981 (1993)
- Yeh TF, "Core concepts: meconium aspiration syndrome:pathogenesis and current management", NeoReviews, 11, pp.e503~e512 (2010)
- Kamat M, "Meconium aspiration syndromepathogenesis and current management", Neonatology Today, 4, pp.1~8 (2009)
- Mahmoud EL, "Motilin levels in term neonates who have passed meconium prior to birth", J Pediatr Gastroenterol Nutr, 7, pp.95~99 (1988)
- Piper JM, "Meconium: a marker for peripartum infection", Obstet Gynecol, 91, pp.741~745 (1998)
- Rapoport S, "The composition of Meconium;isolation of blood-group-specific polysaccharides; abnormal compositions of meconium in meconium ileus", Science, 112, pp.150~153 (1950)
- Cote RH, "Isolation, composition and reactivity of the neutral glycoproteins from human meconiums with specificities of the ABO and Lewis systems", Biochem J, 153, pp.63~73 (1976)
- Findlay RD, "Surfactant replacement therapy for meconium aspiration syndrome", Pediatrics, 97, pp.48~52 (1996)
- Dargaville PA, "The epidemiology of meconium aspiration syndrome: incidence, risk factors, therapies, and outcome", Pediatrics, 117, pp.1712~1721 (2006)
- Yeh TF, "Lung volume, dynamic lung compliance, and blood gases during the first 3 days of postnatal life in infants with meconium aspiration syndrome", Crit Care Med, 10, pp.588~592 (1982)
- Ghidini A, "Severe meconium aspiration syndrome is not caused by aspiration of meconium", Am J Obstet Gynecol, 185, pp.931~938 (2001)
- Wu JM, "The role of pulmonary inflammation in the development of pulmonary hypertension in newborn with meconium aspiration syndrome (MAS)", Pediatr Pulmonol Suppl, 18, pp.205~208 (1999)
- Yeh TF, "Roentgenographic findings in infants with meconium aspiration syndrome", Jama, 242, pp.60~63 (1979)
- Cleary GM, "Meconium-stained amniotic fluid and the meconium aspiration syndrome. An update", Pediatr Clin North Am, 45, pp.511~529 (1998)
- Yoder BA, "Changing obstetric practices associated with decreasing incidence of meconium aspiration syndrome", Obstet Gynecol, 99, pp.731~739 (2002)
- Newman B, "Imaging of medical disease of the newborn lung", Radiol Clin North Am, 37, pp.1049~1065 (1999)
- Wenstrom KD, "The prevention of meconium aspiration in labor using amnioinfusion", Obstet Gynecol, 73, pp.647~651 (1989)
- Eriksen NL, "Prophylactic amnioinfusion in pregnancies complicated by thick meconium", Am J Obstet Gynecol, 171, pp.1026~1030 (1994)
- Spong CY, "Prophylactic amnioinfusion for meconium-stained amniotic fluid", Am J Obstet Gynecol, 171, pp.931~935 (1994)
- Fraser WD, "Amnioinfusion for the prevention of the meconium aspiration syndrome", N Engl J Med, 353, pp.909~917 (2005)
- "Neonatal Resuscitation Program®" (2017)[URL]
- Wiswell TE, "Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial", Pediatrics, 105, pp.1~7 (2000)
- Carson BS, "Combined obstetric and pediatric approach to prevent meconium aspiration syndrome", Am J Obstet Gynecol, 126, pp.712~715 (1976)
- Vain NE, "Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders:multicentre, randomised controlled trial", Lancet, 364, pp.597~602 (2004)
- Gregory GA, "Meconium aspiration in infants--a prospective study", J Pediatr, 85, pp.848~852 (1974)
- Clark RH, "Prospective, randomized comparison of high-frequency oscillation and conventional ventilation in candidates for extracorporeal membrane oxygenation", J Pediatr, 124, pp.447~454 (1994)
- Roberts JD, "Inhaled nitric oxide in persistent pulmonary hypertension of the newborn", Lancet, 340, pp.818~819 (1992)
- Clark RH, "Low-dose nitric oxide therapy for persistent pulmonary hypertension of the newborn. Clinical Inhaled Nitric Oxide Research Group", N Engl J Med, 342, pp.469~474 (2000)
- Konduri GG, "A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure", Pediatrics, 113, pp.559~564 (2004)
- Kinsella JP, "Randomized, multicenter trial of inhaled nitric oxide and high-frequency oscillatory ventilation in severe, persistent pulmonary hypertension of the newborn", J Pediatr, 131, pp.55~62 (1997)
- Lin HC, "Role of antibiotics in management of non-ventilated cases of meconium aspiration syndrome without risk factors for infection", Biol Neonate, 87, pp.51~55 (2005)
- Wiswell TE, "Meconium aspiration syndrome: have we made a difference?", Pediatrics, 85, pp.715~721 (1990)
- Lotze A, "Multicenter study of surfactant (beractant) use in the treatment of term infants with severe respiratory failure. Survanta in Term Infants Study Group", J Pediatr, 132, pp.40~47 (1998)
- Baquero H, "Oral sildenafil in infants with persistent pulmonary hypertension of the newborn: a pilot randomized blinded study", Pediatrics, 117, pp.1077~1083 (2006)
- Hintz SR, "Decreased use of neonatal extracorporeal membrane oxygenation (ECMO): how new treatment modalities have affected ECMO utilization", Pediatrics, 106, pp.1339~1343 (2000)
- Macfarlane PI, "Pulmonary function in children after neonatal meconium aspiration syndrome", Arch Dis Child, 63, pp.368~372 (1988)
- Swaminathan S, "Long-term pulmonary sequelae of meconium aspiration syndrome", J Pediatr, 114, pp.356~361 (1989)