Meconium aspiration syndrome ( SAM ) is a respiratory disorder caused by inhalation of meconium from amniotic fluid within the bronchial tree .
Meconium is called the first bowel movements of the newborn. It is a green-blackish and very sticky substance that is made up of waste contained in the amniotic fluid that the unborn baby is swallowing, such as epithelial remains, lanugo, fat from the caseous vernix and intestinal secretions. When you start breastfeeding, stools change in consistency and color.
It is a sterile substance in the intestine, but when inhaled it can cause damage to the lungs such as infection and even suffocation.
The normal thing is that the baby eliminates the meconium the days after the birth. But if you suffer from a lack of oxygen within the womb or during labor, an increase in bowel movement and relaxation of the anal sphincter can occur, eliminating part of the meconium in the amniotic fluid, which can be aspirated.
Aspiration can occur before, during or immediately after delivery due to remains of meconium that may have remained in the pharynx and trachea.
What can happen if there is aspiration of meconium
In about 12 percent of deliveries the baby expels meconium, however, it is not always aspirated. Meconium aspiration syndrome ( SAM ) is present in only 4 percent of cases, and some are more severe than others, depending on the amount, consistency, and length of time the meconium has remained in the airways.
If it is aspirated, it can cause meconium aspiration pneumonia and obstruction of the bronchi.
In these cases, in childbirth, as soon as the head appears, the baby’s mouth is sucked to remove traces of meconium before the first breath occurs and it expands throughout the pulmonary tree.
If the baby does not respond and is not vigorous at birth, a tube is placed in the windpipe to suck the meconium out of the airways. Although if the meconium is thin, intubation may be unnecessary.
If the meconium aspiration has been more severe, the baby will need specialized care in the intensive care unit .
Complications from meconium aspiration can range from shortness of breath that persists for a few days, to aspiration pneumonia, pulmonary hypertension, brain damage from lack of oxygen, and in extreme cases, death of the baby.
Symptoms and signs of meconium aspiration
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It is important to observe the color of the amniotic fluid when the water breaks. It must be light in color, since if it is stained greenish, it is a sign that it contains traces of meconium.
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Breathing difficulty in the newborn baby: respiratory arrest, effort to breathe, rapid breathing, abnormal breath sounds.
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Cyanosis in the baby (blue-colored skin due to lack of oxygen)
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Slow heart rate that could indicate fetal distress. (detected in monitoring)
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The newborn can give a low score on the Apgar test, a test that is performed on the baby as soon as it is born.
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The vernix (unctuous substance that the baby presents at birth), the nails and the umbilical cord may be stained with meconium depending on the time they have been exposed to the substance.
Risk factor’s
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Preeclampsia and hypertension in the mother
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Complications in labor or prolonged labor
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Hypoxia: decreased oxygen delivered to the baby within the uterus
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Mother’s diabetes
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Post-term pregnancy (babies past the due date)
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Delayed intrauterine growth (small for gestational age babies)
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Fetal suffering
In most cases, meconium aspiration syndrome ( SAM ) has a good prognosis and the baby makes a full recovery.
More information | Colombian Academy of Pediatrics and Periculture
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