Meconium aspiration syndrome (MAS) is a serious medical condition where a baby inhales meconium (the baby’s first stool) and amniotic fluid deep into the lungs before or around the time of delivery. Meconium is normally stored in the baby’s intestines until after birth. Sometimes, however, the meconium is expelled while the baby is still in the uterus due to stress or being post term.
Meconium aspiration can cause very serious problems, including:
- Airway blockage
- Inflamed airways
If a baby is at risk for MAS, staff must conduct fetal monitoring during labor and delivery in order to prevent dangerous complications. When monitoring shows the baby is not receiving enough blood or oxygen, or if the baby’s heart rate is slow, doctors must act quickly to restore blood flow and oxygen supply to prevent hypoxic ischemic encephaolopathy (HIE). An emergency C-section is usually necessary in these cases and a team of pediatric specialists skilled at reviving newborns should be present.
Swift Resuscitation Often Necessary with Meconium Aspiration Syndrome
Even a five-minute oxygen deprivation episode can cause very serious damage to a newborn. It is critical that resuscitation occur immediately to ensure the health of the baby. If doctors suspect the baby has MAS but has a good respiratory effort, heart rate, and muscle tone, resuscitation efforts are probably not needed. If the baby is limp, not crying, or slow to begin breathing, the medical team should begin resuscitation immediately.
Some or all of the following are required to resuscitate a non-vigorous/depressed baby:
- Airway Clearance / Suctioning: This is the process of putting a tube or suction catheter into the baby’s trachea and applying suction pressure to draw out the meconium and mucus that are in the upper airway preventing it from being inhaled deeper into the lungs.
- Positive Pressure Ventilation (PPV) with a bag: When a baby’s heart rate, blood pressure or oxygen level drops or if carbon dioxide rises and the baby needs help breathing, he should be either be intubated or given a mask. PPV with a bag is a procedure in which a member of the medical team attaches a device, called a bag, to the baby’s ET tube or mask and breathes for the baby by squeezing the bag, which forces air or oxygen into the baby’s lungs. This is the method of breathing for a baby during an emergency situation, such as during CPR or while waiting to place the baby on a breathing machine (ventilator).
- Intubation: This is the placement of a flexible tube (endotracheal, or ET tube) into the trachea (windpipe) to maintain an open airway. The tube can be placed through the nose and into the trachea, or, more commonly, through the mouth and into the trachea. Intubation generally occurs if, after PPV with a mask, the baby’s heart rate is still slow, there is not much rise in the chest with each inflation of the bag, and/or the baby’s oxygen level does not improve, or if there are a lot of secretions in the airway that require frequent suctioning. Almost all non-vigorous babies that have aspirated meconium are intubated.
- Oxygen: The administration of oxygen can mean the difference between life and death of the baby. As with all resuscitation procedures, the medical team is required to follow guidelines and target ranges for oxygen levels to ensure that the baby gets enough oxygen in the blood, but not so much that it causes damage. In fact, initial resuscitation efforts should be done using regular air, and oxygen should be added only if the baby’s oxygen saturation falls below the target range.
- Chest compressions/CPR: This is where two or three fingers are used to gently press down on the center of the baby’s chest to help push blood through the heart and surrounding vessels when the baby’s heart rate is slow. When chest compressions are combined with bagging, it is called CPR. The goal is to restore spontaneous breathing and blood circulation, and to provide partial flow of oxygenated blood to the brain so that the tissue doesn’t die and brain damage doesn’t occur or is minimized. The longer a baby is deprived of sufficient oxygen and blood flow, the greater the chances of severe problems, including brain damage and death. It is essential that the medical team initiate CPR quickly.
Additionally, there are other procedures that should be utilized when a baby requires emergency and/or resuscitative efforts following meconium aspiration:
- Umbilical arterial catheter (UAC): This a line inserted into the baby’s artery in the umbilical cord stump. The UAC is used to monitor blood pressure, oxygenation / ventilation, lung and kidney functioning, and carbon dioxide and pH levels in the baby’s blood. The UAC is usually placed in the baby immediately after birth if there is any suspicion that the baby could have heart or breathing problems.
- If there is no UAC placed, a machine connected to a small blood pressure cuff wrapped around the baby’s arm or leg can be used to measure blood pressure. The cuff automatically takes the baby’s blood pressure at regular times and displays the numbers on a screen.
- Cardiopulmonary monitor: This machine tracks the baby’s heart and breathing rates and is important if the baby does not have a UAC. It is connected to the baby by small adhesive monitoring pads placed on the chest. A monitor displays information on the screen, which can be printed onto paper.
- Pulse oximeter: This device is placed on the baby’s finger or toe, and a wire connects it to a machine that continuously displays the oxygen level in the baby’s arterial blood.
When Medical Staff Do Not Follow or Incorrectly Follow Standards of Care
When meconium aspiration is confirmed either prior to or at birth and the baby is in distress, it is the responsibility of doctors and nurses to use these methods quickly and correctly to avoid a lack of oxygen to the baby’s brain. When done too slowly or improperly, it may result in permanent brain damage, hypoxic ischemic encephalopathy (HIE), cerebral palsy, seizures, learning and mental disabilities, and more. This constitutes medical malpractice.
Call Reiter & Walsh ABC Law Centers for Trusted Help
If you or someone you know gave birth with meconium stained fluid present and the baby now has brain damage, cerebral palsy, intellectual impairments, or other disabilities, please call our experienced birth injury attorneys at 888-419-2229. Reiter & Walsh ABC Law Centers will review your case along with our team of nationally-recognized medical experts and determine if doctors performed all necessary medical procedures properly and timely. If not, we will aggressively seek compensation for the child.
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