Meconium Aspiration Syndrome Workup

  • Author: Melinda B Clark, MD; Chief Editor: Ted Rosenkrantz, MD   more...
 
Updated: Mar 30, 2010
 

Laboratory Studies

The following studies are indicated in suspected meconium aspiration syndrome (MAS):

  • Acid-base status
    • Ventilation-perfusion (V/Q) mismatch and perinatal stress are prevalent and assessment of acid-base status is crucial.
    • Metabolic acidosis from perinatal stress is complicated by respiratory acidosis from parenchymal disease and persistent pulmonary hypertension of the newborn (PPHN).
    • ABG measurement of pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), and continuous measurement of oxygenation by pulse oximetry are necessary for appropriate management.
  • Serum electrolytes: Obtain sodium, potassium, and calcium concentrations at 24 hours of life in infants with meconium aspiration syndrome because the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and acute renal failure are frequent complications of perinatal stress.
  • CBC count
    • In utero or perinatal blood loss, as well as infection, contributes to postnatal stress.
    • Hemoglobin and hematocrit levels must be sufficient to ensure adequate oxygen-carrying capacity.
    • Thrombocytopenia increases the risk for neonatal hemorrhage.
    • Neutropenia or neutrophilia with left shift of the differential may indicate perinatal bacterial infection.
    • Polycythemia may be present secondary to chronic or acute fetal hypoxia. Polycythemia is associated with decreased pulmonary blood flow and may exacerbate the hypoxia associated with meconium aspiration syndrome and PPHN.
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Imaging Studies

  • Chest radiography is essential in order to achieve the following:
    • Confirm the diagnosis of meconium aspiration syndrome and determine the extent of intrathoracic pathology (see images below)
    • Identify areas of atelectasis and air block syndromes (see images below)
    • Ensure appropriate positioning of the endotracheal tube and umbilical cathetersAir trapping and hyperexpansion from airway obstruAir trapping and hyperexpansion from airway obstruction. Acute atelectasis. Acute atelectasis. Pneumomediastinum from gas trapping and air leak. Pneumomediastinum from gas trapping and air leak. Left pneumothorax with depressed diaphragm and minLeft pneumothorax with depressed diaphragm and minimal mediastinal shift because of noncompliant lungs. Diffuse chemical pneumonitis from constituents of Diffuse chemical pneumonitis from constituents of meconium.
  • Later in the course of meconium aspiration syndrome, when the infant is stable, imaging studies of the brain (eg, MRI, CT scanning, cranial ultrasonography) are indicated, if the infant's neurologic examination is abnormal.
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Other Tests

  • Echocardiography is necessary to ensure normal cardiac structure and assess cardiac function, as well as determine the severity of pulmonary hypertension and right-to-left shunting.
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Contributor Information and Disclosures
Author

Melinda B Clark, MD  Assistant Professor of Pediatrics, Department of Pediatrics, Albany Medical College

Melinda B Clark, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Coauthor(s)

David A Clark, MD  Chairman, Professor, Department of Pediatrics, Albany Medical College

David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven M Donn, MD  Professor of Pediatrics, University of Michigan Medical School; Director, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan Health System

Steven M Donn, MD is a member of the following medical societies: American Pediatric Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP  Professor of Pediatrics (Neonatology), Vanderbilt University School of Medicine; Director, Neonatal Follow-up Program, Monroe Carell Jr Children's Hospital at Vanderbilt

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, National Hospice and Palliative Care Organization, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Carol L Wagner, MD  Professor of Pediatrics, Medical University of South Carolina

Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD  Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine

Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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Air trapping and hyperexpansion from airway obstruction.
Acute atelectasis.
Pneumomediastinum from gas trapping and air leak.
Left pneumothorax with depressed diaphragm and minimal mediastinal shift because of noncompliant lungs.
Diffuse chemical pneumonitis from constituents of meconium.
 
 
 
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