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Meconium and Related Conditions

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Meconium is the first stool or feces of a newborn soon after birth, even before they start to feed and digest milk.

Medically reviewed by

Dr. Veerabhadrudu Kuncham

Published At September 27, 2022
Reviewed AtOctober 5, 2022

Introduction:

Meconium is the initial substance present in the newborn’s intestines. They form the first bowel movement of the baby. A full-term baby generally passes meconium only after 24 to 48 hours following birth. They are generally green, yellow, or brown in color. It is an odorless, dense, sticky material consisting of water, skin, desquamated cells of the intestine, gastrointestinal secretions, bile, pancreatic juice, etc. In the case of a preterm baby, there is a delay in the passage of meconium. In this article, you will get to grasp more information about meconium, its importance, complications associated, and the management of a baby born with meconium aspiration.

Why Is It Important to Know About Meconium?

When your newborn passes its first stool or meconium after 24 to 48 hours after delivery, it means that the baby is healthy with an intact patent intestinal system. This is important for a newborn’s initial examination. In some cases, the body does not pass meconium even after 48 hours. Failure to do so indicates the presence of any underlying disease or obstruction of the infant's bowel.

What Are Some of the Conditions of Delayed Meconium Passage?

  • Hirschsprung Disease: It is an intestinal disorder causing difficulty in passing the stool.

  • Meconium Plug Syndrome: Blockage of the large intestine due to thick intestinal contents.

  • Meconium Ileus: The baby’s first stool gets blocked in the small intestine.

  • Anorectal Malformations: Birth defects of the anus and the rectum.

  • Small Left Colon Syndrome: It is a functional disorder causing intestinal obstruction.

  • Intestinal Atresias: It is a congenital disorder that results in complete obstruction of the intestines.

  • Hypothyroidism: A condition where the thyroid gland does not produce adequate thyroid hormone.

  • Sepsis: When the body responds to the infection resulting in tissue damage.

  • Electrolyte Imbalance: Too much fluid loss and acid-base imbalance in the body.

  • Maternal Medications- Such as magnesium sulfate.

Can the Baby Pass Meconium Before Birth?

The answer to this question is yes. Sometimes the baby may pass the meconium while in the uterus itself when the baby is under stress or in the presence of any other underlying conditions such as problems with the placenta or umbilical cord, which results in meconium passage prior to birth.

What Are the Risk Factors?

The factors that contribute to meconium passage are:

  • Inadequate blood and oxygen supply.

  • Aging of the placenta or postdate pregnancy.

  • High blood pressure in the mother.

  • Maternal diabetes.

  • Stressful labor (difficulty in the delivery or long hours of labor)

What Are the Symptoms of Early Meconium Passage?

Most babies do not breathe the meconium into the lungs. They are usually asymptomatic. It is only when the meconium gets aspirated into the lungs problems occur. Some signs that indicate meconium in your baby are:

  • Bluish discoloration of the skin is called cyanosis.

  • Difficulty in breathing.

  • Absence of breathing (apnea).

  • Dark, greenish staining of amniotic fluid.

How to Diagnose This Condition?

  • Prenatal assessments using a fetal monitor show a slow heart rate.

  • Meconium stains are seen in the amniotic fluid.

  • Crackling or abnormal breathing sounds are heard through a stethoscope.

  • Blood gas analysis: It indicates low blood acidity, decreased oxygen, and increased carbon dioxide levels.

  • X-ray of the chest shows patchy or streaky areas on the lungs.

What Is the Complication?

When the baby passes meconium into the amniotic fluid, there are high chances for the baby to breathe it into the lungs. This leads to a condition called “meconium aspiration syndrome.” Not all babies who pass the meconium breathe it into their lungs. Sometimes it is just passed into the amniotic fluid. This fluid is called “ meconium-stained amniotic fluid (MSAF).”

What Is Meconium Aspiration Syndrome?

It is a clinical condition characterized by respiratory failure in newborns through meconium-stained amniotic fluid. It is uncommon before 34 weeks of gestation. It is seen in near-term, term, or post-term infants. The meconium-stained amniotic fluid accounts for 22 % of all births, and only 3 to 12 % of cases develop meconium aspiration syndrome.

The babies born through meconium-stained fluid have an increased chance of developing perinatal asphyxia and respiratory distress. In order to avoid these complications, induction of labor is advised at or after 42 weeks of gestation.

How Should the Baby Born Through Meconium-Stained Fluid Be Treated?

Soon after the rupture of the fetal membrane, the color of the amniotic fluid should be assessed. In general, amniotic fluid is a clear or straw-colored fluid. But the case of brown-orange staining indicates the passage of meconium. In this case of meconium staining, the neonatal resuscitation team should be involved.

In earlier studies, if meconium staining is encountered, an intrapartum suctioning of airways was done. But the latest guidelines do not recommend intrapartum suctioning before the delivery of the shoulders.

Based on the infant’s behavior and responsiveness, the treatment protocol is categorized into:

When the baby is active with good muscle tone and respiratory function.

  • In the first condition, if the baby is active with good muscle tone and respiratory functions, suctioning of the fluid from the oropharynx is not advisable.

  • If the airway is obstructed, then airway clearance is recommended. This is followed by close monitoring of the infant in the neonatal intensive care unit (NICU).

When a baby is inactive with poor muscle tone.

In the second condition, if the baby is not active with a poor muscle tone and insufficient breathing, then:

  • Immediate management to support ventilation and oxygenation is recommended.
  • Endotracheal intubation for positive pressure ventilation.
  • In case of airway obstruction, airway clearance with suctioning of meconium is recommended.
  • The neonatal resuscitation team’s involvement is advisable.

What Are the Other Treatments Included?

  • Antibiotics to treat infections.

  • Lungs to be kept inflated using a breathing machine.

  • Use warmers to maintain the body temperature.

  • The gentle tapping of the chest loosens the secretions.

  • Metabolic acidosis or disorders such as hypoglycemia should be corrected.

  • Hyperventilation should be avoided as it may lead to respiratory alkalosis and neurodevelopmental impairment.

  • The American Academy of Pediatrics recommends the use of surfactants administered through bolus or bronchial lavage to reduce the need for extracorporeal membrane oxygenation (ECMO). The bolus surfactant therapy improves respiratory function and oxygenation within six hours.

What Is the Outlook on Meconium Aspiration Syndrome?

In most cases, the prognosis is excellent, and there are no long-term effects. The infant gets better within three to four days after the treatment has started. In severe cases of aspiration, the infant may require a breathing machine.

Conclusion:

Despite adequate knowledge, meconium aspiration syndrome remains a challenging condition. Regular prenatal visits and a stress-free pregnancy reduce the stress on the baby in the womb, thus reducing the chances of meconium-stained fluid. Parents of the newborn should be educated and understand that the baby requires monitoring at a neonatal intensive care unit. Early and appropriate treatment can prevent respiratory distress and other complications in the baby.

Frequently Asked Questions

1.

What Does Meconium Staining Indicate?

Meconium is the feces or first stool passed by the newborn after birth is the initial bowel movement in the baby. Meconium staining is when this stool passed by newborns mixes into the amniotic fluid. This serious condition can cause meconium aspiration syndrome in the baby.

2.

Does Meconium Have Long-Term Effects?

Meconium can cause long-term effects in some babies, including developmental abnormalities, chronic lung disease, hearing loss, bacterial pneumonia, and severe asthma-like symptoms. Meconium can also cause severe long-term meconium aspiration syndrome, which can have fatal consequences.

3.

Is Meconium an Indication for Cesarean Section?

When meconium gets into the amniotic fluid, it increases the chances of a cesarean or C-section. In addition, meconium can cause infection or increase the feto-maternal stress factor in intrauterine meconium passage. Therefore, a cesarean may be indicated in such cases.

4.

Does Meconium Cause Cerebral Palsy?

Cerebral palsy is caused by damage to the baby’s brain during pregnancy, delivery during labor, or immediately after birth. It is a complex condition. Meconium can be a cause or sign of oxygen deprivation in a fetus by blocking the airway during labor and thus can cause cerebral palsy. Further, it can lead to oxygen insufficiency in the uterus which can cause permanent brain damage in the baby along with other lifelong disabilities. Therefore, a newborn may require external oxygen support to cope with oxygen insufficiency caused by meconium.

5.

When Should a Person Worry About Meconium?

A person should worry about meconium if a baby shows symptoms such as difficulty breathing, rapid breathing, grunting, or noisy breathing. A baby may also indicate a lack of movement or limpness. Also, a newborn doesn't cry and has poor fetal monitoring results.

6.

What Leads to Meconium in Amniotic Fluid?

Meconium in amniotic fluid is caused by intrauterine distress. The condition is caused due to the following factors:
- Maternal hypertension.
- Infections. 
- Placental insufficiency.
- Maternal drug abuse.
- Preeclampsia.
- Acidosis.
- Oligohydramnios.

7.

What Are the Complications Associated With Meconium?

The complications associated with meconium are as follows:
- Meconium aspiration syndrome.
- Blocked airways.
- Pneumonia or lung infections.
- Brain damage due to oxygen insufficiency.
- Persistent pulmonary hypertension in babies.
- Pneumothorax or lung collapse.

8.

Can We Treat Meconium?

Meconium can be treated in the following ways:
- Antibiotics to treat infections.
- Warmers are used to maintain body temperature.
- Metabolic disorders such as hypoglycemia are treated.
- Breathing machines are used to keep the lungs inflated.
- Gentle tapping is done to remove the secretion of the lungs.

9.

What Happens When a Baby Does Not Poop Meconium?

If a baby fails to pass meconium, it indicates an obstruction in the bowel movement or association with some underlying medical condition. The condition also causes a distended abdomen, feeding difficulties, and vomiting in newborns. In addition, meconium can cause a respiratory emergency in a baby if it does not pass in the first 24 hours after birth.

10.

How Common Is Meconium Ileus?

Meconium ileus occurs in almost one out of every 1500 live births—about 20 percent of newborns with cystic fibrosis develop meconium ileus. Meconium ileus is one of the early symptoms of cystic fibrosis.

11.

What Disease Can Lead to Meconium Ileus?

Cystic fibrosis can cause meconium ileus in a person. The condition can lead to the excessive thickening of meconium fluid in the intestines and, thus, causes blockage in the passage. The thick intestinal secretion gets stuck to the inner lining of the intestines and causes obstruction.

12.

Is Meconium Ileus an Emergency?

Meconium ileus is an emergency condition if not treated timely because it causes obstruction to food inside the ileus if not treated timely. In addition, the disease can cause the death of tissues by destroying the blood supply to the intestines. This can further cause infection in the abdominal cavity and intestinal tears that can have fatal consequences.

13.

Do Babies Recover From Meconium Aspiration?

Yes, most babies do recover from meconium aspiration completely. This is because infants are mainly at a high risk of wheezing and lung infections in the first few years of their life. However, with immediate treatment, Iconium aspiration occurs in many cases.

14.

What Are the Five Initial Steps of Newborn Care?

The first initial steps of newborn care are as follows:
- Nurturing care.
- Thermal care.
- Prevention of infections.
- Breastfeeding.
- Through drying, skin-to-skin touch, breathing assessment, and delayed cord clamping.
Dr. Veerabhadrudu Kuncham
Dr. Veerabhadrudu Kuncham

Pediatrics

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