Meconium aspiration

4.76K views
meconium-aspiration

What is meconium aspiration

Meconium aspiration occurs when a baby breathes in amniotic fluid containing meconium (the baby’s first stools, a dark, thick substance that forms in the baby’s intestines). Meconium is passed into the amniotic fluid in about 10 percent of births. It usually occurs in babies born at term (37 to 41 weeks) or post-term (after 42 weeks).

Meconium particles in the amniotic fluid can block small airways and prevent the exchange of oxygen and carbon dioxide after birth. Some babies have immediate respiratory distress and have to be resuscitated at birth. Others develop respiratory distress within a few hours.

Some babies with meconium aspiration need a mechanical ventilator (breathing machine) because of the difficulty breathing. The plugged airways may cause air to be trapped and leak into the tissues in and around the lungs. Infection can also occur causing pneumonia. Although the condition often improves within a few days, severe meconium aspiration, and the respiratory problems it causes, may lead to death in a small number of babies.

What is meconium?

Meconium is your baby’s first poop. Meconium is dark green, brown, or yellow, thick, sticky and tar-like substance that forms in the fetal intestines and made up of cells, mucus, hair, bile and other materials 1. It was noticed that in utero meconium passage is more common in late-term and post-term babies after 37 weeks of gestation 2. Babies typically pass meconium within 48 hours of birth. In some cases, babies will pass meconium during labor and delivery, putting them at risk of aspirating (or inhaling) the tacky substance.

What happens when a baby swallows meconium?

Swallowing meconium is okay. A fetus (unborn baby) practices swallowing by drinking amniotic fluid. So if a baby release small amounts of meconium and swallow it, it’s not a cause for worry. On the other hand, inhaling (aspirating) meconium into a baby’s lungs can be dangerous.

Why is meconium aspiration dangerous?

Meconium has a thick and sticky texture. It’s so sticky that it’s often hard to get off your baby’s bottom with a wipe. Imagine this substance in a newborn’s lungs. It can get stuck inside your baby’s airways, prevent their lungs from inflating and deprive them of air.

What causes meconium aspiration?

Before or during labor, the fetus sometimes passes the meconium stool into the amniotic fluid. It is not clearly understood why this happens. It may be a natural event, but it is also thought to be related to fetal distress in some babies. When the thick meconium mixes into the amniotic fluid, it is swallowed and breathed into the airway of the fetus. As the baby takes the first breaths at delivery, meconium particles enter the airway and can be aspirated (inhaled) deep into the lungs.

Meconium aspiration prevention

To prevent problems that lead to meconium being present, stay healthy during pregnancy and follow your health care provider’s advice.

Your doctor will want to be prepared for meconium being present at birth if:

  • Your water broke at home and the fluid was clear or stained with a greenish or brown substance.
  • Any testing done during your pregnancy indicates there may be problems present.
  • Fetal monitoring shows any signs of fetal distress.

Early identification of meconium aspiration is essential to preventing severe aspiration problems. A technique called amnioinfusion is sometimes used during labor with meconium-stained amniotic fluid. This procedure uses a small tube inserted into the uterus through the vagina. Sterile fluid is then infused through the tube to help dilute the thick meconium.

Meconium aspiration symptoms

Meconium in the amniotic fluid gives the fluid a greenish color. This is called meconium staining. Babies who have been exposed to meconium in the amniotic fluid for a long time may have yellowed skin and nails.

The following are the most common symptoms of meconium aspiration. However, each baby may experience symptoms differently. Symptoms may include:

  • Rapid breathing
  • Retractions (pulling in of the chest wall)
  • Grunting sounds with breathing
  • Cyanosis (blue coloring)
  • Overdistended chest because of trapped air

The symptoms of meconium aspiration may resemble other conditions or medical problems. Always consult your baby’s doctor for a diagnosis.

Meconium aspiration diagnosis

The presence of meconium in the amniotic fluid is key to the diagnosis. A chest X-ray also helps diagnose meconium aspiration. X-rays are a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Meconium aspiration treatment

Early detection is key. A fetal monitor can detect if your baby is experiencing stress. If your doctor thinks your baby may have inhaled meconium, a special care team should be present during delivery. If after the baby is born, he’s active and crying, no treatment is necessary.

However, if the baby has trouble breathing, the doctor will quickly need to clear away as much meconium as possible to decrease the amount of meconium the baby inhales. He’ll suction the mouth, nose, and throat. Then he’ll insert a tube called a laryngoscope down the baby’s throat and into the trachea to remove any meconium there.

Specific treatment for meconium aspiration will be determined by your child’s doctor based on the following:

  • The amount and thickness of the meconium
  • The length of time the baby was exposed
  • The degree of respiratory distress

At delivery, treatment may include:

  • Suctioning of the upper airways (nose, mouth, and throat)
  • Suctioning of the lower airways through an endotracheal tube (ET) placed in the windpipe, although this is not recommended routinely unless it is necessary
  • Supplemental oxygen given by face mask or mechanical ventilator

If your baby is not breathing or has a low heart rate, a facemask with oxygen can help inflate the baby’s lungs and help him or her breathe. Your baby may need to be monitored closely in a newborn intensive care unit (NICU). In the NICU, he or she may get:

  • Oxygen therapy.
  • Antibiotics to treat infection.
  • Surfactant (a substance that helps the lungs expand properly).
  • A radiant warmer to control his temperature.
  • Frequent blood tests to see if he’s getting enough oxygen.

Meconium aspiration long term effects

In most cases of meconium-stained fluid, the outlook is excellent and there are no long-term health effects. While rapid breathing may continue for several days, it’s rare for a baby with meconium aspiration syndrome to experiences any long-term damage. However, babies who experienced meconium aspiration syndrome may be at higher risk for an asthma-like disease called “reactive airway disease.” This can cause wheezing, coughing, and shortness of breath.

  • Only about one half of babies with meconium-stained fluid will have breathing problems and only about 5% will have meconium aspiration syndrome.
  • Babies may need extra support with breathing and nutrition in some cases. This need will often go away in 2 to 4 days. However, rapid breathing may continue for several days.
  • Meconium aspiration syndrome rarely leads to permanent lung damage.

Meconium may be present at birth in the amniotic fluid because there is a serious problem with the blood flow to and from the lungs. This is called persistent pulmonary hypertension of the newborn.

Meconium aspiration syndrome

Meconium aspiration syndrome (MAS) refers to serious breathing problems that a newborn baby may have when 3, 4:

  • There are no other causes, and
  • The baby has passed meconium (stool) into the amniotic fluid (the fluid surrounding the baby in the womb) during labor or delivery. Meconium is the first stool of a newborn (baby’s first poop), a dark green, brown, or yellow, thick substance that forms in the fetal intestines 5. Meconium is passed into the amniotic fluid in about 10 to 20 percent of births 6, 7, 8, 9. It’s given the term “meconium-stained amniotic fluid” (MSAF). Meconium-stained amniotic fluid usually occurs in babies born at term (37 to 41 weeks) or post-term (after 42 weeks) 2..
  • Meconium aspiration is when a newborn baby breathes in a sticky substance called meconium just before or during birth. Amniotic fluid that contains meconium will appear greenish-brown when the amniotic sac ruptures. Babies exposed to meconium-stained amniotic fluid may have yellow skin and nails at birth. Doctors know what to look for and are trained to detect meconium aspiration. Only 2% to 10% of babies born through meconium-stained amniotic fluid develop meconium aspiration syndrome (MAS) 10, 11.

Meconium aspiration syndrome (MAS) happens if the baby breathes in (aspirates) meconium-stained amniotic fluid into his/her lungs just before or during birth and it causes breathing problems and respiratory distress. Meconium particles in the amniotic fluid can block or irritate your baby’s small airways and prevent the exchange of oxygen and carbon dioxide after birth and damage lung tissue and block surfactant (the substance that helps open your baby’s lungs at birth). Some babies have immediate respiratory distress and have to be resuscitated at birth. Others develop respiratory distress within a few hours. Some babies with meconium aspiration need a mechanical ventilator (breathing machine) because of the difficulty breathing. The plugged airways may cause air to be trapped and leak into the tissues in and around the lungs (pneumothorax). Infection can also occur causing pneumonia (lung infection). Although meconium aspiration syndrome (MAS) often improves within a few days, severe meconium aspiration, and the respiratory problems it causes, may lead to death in a small number of babies. Early detection and fast treatment improve the outcomes. It’s rare for meconium aspiration syndrome (MAS) to cause long-term complications or health conditions.

Meconium aspiration can happen for several reasons, but fetal stress is the most common. Examples of fetal stress could be an infection or low oxygen levels. Stress makes your baby take strong, deep gasps. This forceful gasp causes your baby to inhale amniotic fluid deep into his/her lungs. If the amniotic fluid contains meconium, the meconium gets into your baby’s lungs. The aspirated meconium fills your baby’s airways, making it hard to breathe.

The treatment for meconium aspiration syndrome (MAS) depends on the volume and consistency of the meconium and the amount of respiratory distress your baby is experiencing. If your baby’s born crying and active, treatment is usually unnecessary.

According to the 2015 guidelines, the American Heart Association, the International Liaison Committee on Resuscitation, and the American Academy of Pediatrics no longer recommend routine endotracheal suctioning for non-vigorous infants with meconium-stained amniotic fluid 12, 13. Infants with meconium-stained amniotic fluid should be observed for signs of MAS.

Meconium aspiration syndrome (MAS) management is mainly supportive, but early identification and support can improve outcomes and decrease morbidity and mortality 3.

The first treatment for meconium aspiration syndrome (MAS) is suction. Doctor and nurses will remove meconium from your baby’s mouth, nose and throat using a bulb syringe. They may insert a tube down your baby’s throat to remove additional meconium from their airway. If your baby still has breathing trouble, they may place a facemask with oxygen on them.

A baby with severe meconium aspiration syndrome (MAS) may need to stay in the neonatal intensive care unit (NICU) for close monitoring and more advanced treatment. This could include:

  • The use of a ventilator.
  • Surfactant or antibiotics to open their lungs and clear any infection.
  • Extracorporeal membrane oxygenation (ECMO).
  • A radiant warmer to help control your baby’s temperature.
  • Continuous positive airway pressure (CPAP).

Figure 1. Meconium aspiration syndrome chest X-ray

Meconium aspiration syndrome chest X-ray

Footnote: Chest X-ray of meconium aspiration syndrome (MAS) showing bilateral diffuse patchy opacities.

[Source 11 ]

How common is meconium aspiration syndrome?

Meconium is passed into amniotic fluid in 10% to 20% of all births. It’s given the term “meconium-stained amniotic fluid”. Meconium-stained amniotic fluid is more common in full-term (40 weeks gestation) or post-term (after 42 weeks gestation) babies. One study reported meconium-stained amniotic fluid in 5.1%, 16.5%, and 27.1% of preterm, term, and post-term newborns, respectively 14. Only 2% to 10% of babies born through meconium-stained amniotic fluid develop meconium aspiration syndrome (MAS) 10, 11. The incidence of MAS is also affected by access to care and is higher in areas where post-term deliveries are frequent. Meconium aspiration syndrome (MAS) was also lower in areas with a high frequency of early cesarean sections, despite other complications associated with cesarean sections 15. One study reported a higher rate of meconium-stained amniotic fluid in Black patients 16.

How long does it take to recover from meconium aspiration syndrome?

Most babies recover from meconium aspiration within a few hours. In serious cases, a baby may need extra time in the neonatal intensive care unit (NICU) or rely on supplemental oxygen for several days or weeks.

Meconium aspiration syndrome causes

Meconium is the early feces (first stool) passed by a newborn soon after birth, before the baby starts to feed and digest milk or formula. In some cases, the baby passes meconium while still inside the uterus. This can happen when babies are “under stress” or “fetal stress” during labor or delivery due to a decrease in blood and oxygen supply causing the baby to pass meconium into the amniotic fluid. This is often due to problems with the placenta or the umbilical cord.

Once the baby passes the meconium into the surrounding amniotic fluid, they may breathe it into the lungs. This may happen:

  • While the baby is still in the uterus
  • During delivery
  • Immediately after birth

The meconium can also block the infant’s airways right after birth. It can cause breathing problems due to swelling (inflammation) in the baby’s lungs after birth.

Risk factors that may cause stress on the baby before birth include:

  • “Aging” of the placenta if the pregnancy goes far past the due date (past 40 weeks)
  • Decreased oxygen to the infant while in the uterus
  • Diabetes in the pregnant mother
  • Difficult delivery or long labor
  • High blood pressure in the pregnant mother
  • Poor intrauterine growth.
  • Post-term babies: Babies born after their due date are at higher risk.
  • Placental insufficiency, low Apgar score at birth, and fetal heart rate abnormalities can also increase the risk.

Meconium aspiration syndrome pathophysiology

The pathophysiology of meconium aspiration syndrome (MAS) is not completely understood. However, 5 important processes have been described: Meconium passage, aspiration, airway obstruction, inflammation, and surfactant inactivation.

  1. Meconium passage: Usually, fecal defecation rarely happens between 20 and 34 weeks of gestation 17. It was noticed that in utero meconium passage is more common in late-term and post-term babies after 37 weeks of gestation 2. Several mechanisms have been hypothesized to play a role in the process, including increased peristalsis, anal sphincter relaxation, and changes in vagal and sympathetic tones in the context of fetal distress and hypoxia.
  2. Aspiration: During the delivery process, fetal breathing usually leads to amniotic fluid moving in and out of the lungs. When amniotic fluid is stained with meconium, the fetus is at risk of aspiration. This is especially true with hypoxia, which can trigger the fetus to increase gasping, which leads to more amniotic fluid inhalation by the fetal airway 18.
  3. Airway obstruction: As meconium is thick and the fetal airways are small in diameter, the presence of meconium in the airways can cause obstruction. The mechanism is similar to a foreign body aspiration. The meconium plug can cause complete obstruction leading to lung collapse distally as well as atelectasis. When partial obstruction occurs, it causes a ball valve effect with increased air trapping, thus increasing the risk of air leak syndromes, notably pneumothorax. Recent data suggest that airway obstruction does not always happen in the context of meconium-stained amniotic fluid and that obstruction alone does not completely explain meconium aspiration syndrome (MAS) 19.
  4. Inflammation: Inflammation plays an important role in the pathogenesis of meconium aspiration syndrome (MAS). Material that constitutes meconium has been shown to trigger inflammatory processes that further contribute to the development of respiratory distress in meconium aspiration syndrome (MAS). Airway inflammation results in a form of chemical pneumonitis. Matrix metalloproteinase-8, interleukin-6, interleukin-8, interferon-gamma, and tumor necrosis factor-alpha have all been described to be significantly higher in patients with meconium aspiration syndrome (MAS) 20, 21.
  5. Surfactant inactivation: Inflammation and hydrolysis can alter and inactivate surfactant 22. This leads to increased surface tension, poor compliance, and impaired oxygenation. Thus, further contributing to the respiratory distress seen in meconium aspiration syndrome (MAS).

All these processes lead to a decrease in alveolar ventilation, causing increased ventilation-perfusion mismatch. This is the main cause of hypoxemia in infants with meconium aspiration syndrome (MAS). Prolonged hypoxemia will trigger pulmonary vascular constriction, which in turn increases pulmonary vascular resistance (PVR). This is often accompanied by right-to-left shunting. These mechanisms can trigger persistent pulmonary hypertension of newborn (PPHN).

Meconium aspiration syndrome prevention

You can’t prevent your baby from aspirating meconium 11. The best thing your doctor can do is monitor your amniotic fluid for meconium and watch for fetal distress. Detecting meconium aspiration early and quickly can prevent severe meconium aspiration syndrome (MAS). Some risk factors for meconium aspiration syndrome (MAS) include:

  • Post-term pregnancy (42 weeks).
  • Diabetes or high blood pressure.
  • Prolonged or difficult labor.
  • Decreased oxygen to the fetus during pregnancy.
  • Fetal growth restriction or intrauterine growth restriction (IUGR)

Meconium aspiration syndrome symptoms

Most babies who have passed meconium into the amniotic fluid do not breathe it into their lungs during labor and delivery. They are unlikely to have any symptoms or problems.

Inhaling or breathing in meconium can be dangerous. Babies who do breathe in (aspirate) meconium-stained amniotic fluid may have the following:

  • Bluish skin color (cyanosis) in the infant
  • Respiratory distress or working hard to breathe (noisy breathing, grunting, using extra muscles to breathe, difficulty breathing, rapid breathing, grunting sounds)
  • Enlarged or bloated chest and retractions (increased use of respiratory muscles)
  • No breathing (lack of respiratory effort, or apnea)
  • Slow heart rate
  • Limpness at birth

Newborn babies with meconium aspiration syndrome (MAS) have trouble breathing. They may breathe too quickly, grunt when they breathe, or use extra muscles to catch their breath. Their skin may have a bluish tint due to lack of oxygen, or a greenish tint from meconium staining. Their blood pressure may also be too low.

Meconium aspiration syndrome complications

Long-term complications of meconium aspiration syndrome are rare nowadays. Most babies who aspirate meconium don’t develop meconium aspiration syndrome (MAS). For the ones who do, only a small amount will develop health conditions. Meconium aspiration syndrome (MAS) is highly treatable, especially if detected early and quickly. Typically, meconium aspiration syndrome (MAS) is managed and treated within a few days.

Newborns with meconium aspiration syndrome are at a slightly higher risk for:

Meconium aspiration syndrome diagnosis

Before birth, the fetal monitor may show a slow heart rate that is slower than expected. During delivery or at birth, meconium can be seen in the amniotic fluid and on the infant. Amniotic fluid that contains meconium will appear greenish-brown when the amniotic sac ruptures. Babies exposed to meconium-stained amniotic fluid may have yellow skin and nails at birth.

If your doctor detect meconium in your amniotic fluid, he/she watch for signs of aspiration after your baby’s born. Because your baby may release meconium before birth but that doesn’t mean your baby will breathe it in. Only 2% to 10% of babies born through meconium-stained amniotic fluid develop meconium aspiration syndrome (MAS). Watching your baby closely for signs of distress is the first step in diagnosing meconium aspiration syndrome (MAS).

Your baby may need help with breathing or heartbeat right after birth. And your baby may have a low Apgar score.

Your baby’s doctor will listen to your baby’s chest with a stethoscope. This may reveal abnormal breath sounds, especially coarse, crackly sounds.

A blood gas analysis will show:

  • Low (acidic) blood pH
  • Decreased oxygen
  • Increased carbon dioxide

Early chest X-ray findings are nonspecific. These include streaky densities bilaterally. Later findings on chest X-ray include hyperinflation, flattening of the diaphragms, and atelectasis. Pneumothorax can also be seen 3.

Echocardiography (ECG) is an important tool to assess heart function and help screen for signs of persistent pulmonary hypertension of newborn (PPHN) and right ventricular dysfunction. It also helps identify the cardiac anatomy and evaluate for any cardiac level right to left shunting.

Blood and tracheal cultures for sepsis and pneumonia is crucial in the context of neonatal distress. Often empiric antibiotics are started.

In some cases, a bronchoscopy (a procedure to view the airways) may be necessary.

Meconium aspiration syndrome differential diagnosis

The differential diagnosis for meconium aspiration syndrome (MAS) includes other causes of newborn distress:

  • Respiratory distress syndrome (RSD): Respiratory Distress Syndrome (RDS) also known as hyaline membrane disease (HMD), is a common breathing disorder in newborns, particularly premature infants, caused by a lack of surfactant, a substance that helps keep the air sacs in the lungs open. Respiratory Distress Syndrome (RDS) is more common in a preterm infant.
  • Transient tachypnea of the newborn (TTN): Transient tachypnea of the newborn (TTN) is a common, self-limited breathing problem that affected babies in the first few hours after birth characterized by rapid breathing (tachypnea) due to delayed clearance of fetal lung fluid. Transient tachypnea of the newborn (TTN) usually resolves within 72 hours.
  • Sepsis/infection/pneumonia: Any newborn with distress should be assessed for infections.
  • Congenital heart disease: Usually diagnosed with an echocardiogram.

Meconium aspiration syndrome treatment

A special care team should be present when the baby is born if traces of meconium are found in the amniotic fluid. This happens in more than 10% of normal pregnancies. If the baby is active and crying, no treatment is needed.

If the baby is not active and crying right after delivery, the team will:

  • Warm and maintain normal temperature
  • Dry and stimulate the baby

This intervention is often all babies need to begin breathing on their own.

If the baby is not breathing or has a low heart rate:

  • The team will help the baby breathe using a face mask attached to a bag that delivers an oxygen mixture to inflate the baby’s lungs.
  • The infant may be placed in the special care nursery or newborn intensive care unit (NICU) in order to be watched closely.

Other treatments may include:

  • Antibiotics to treat possible infection.
  • Breathing machine (ventilator) if baby is unable to breathe on their own or needs a large amount of extra oxygen.
  • Oxygen to keep blood levels normal.
  • Intravenous (IV) nutrition — nutrition through the veins if breathing problems are keeping baby from being able to feed by mouth.
  • Radiant warmer to maintain body temperature.
  • Surfactant: Surfactant is a substance that helps the lungs to expand and function properly, and it may be administered to babies with meconium aspiration syndrome (MAS). Surfactant to help lungs exchange oxygen. Surfactant is only used in more severe cases.
  • Inhaled nitric oxide (also referred to as iNO, an inhaled gas). Inhaled nitric oxide (iNO) helps to relax the blood vessels in baby’s lungs to help blood flow and oxygen exchange in the lungs. This is only used in severe cases.
  • Extracorporeal membrane oxygenation (ECMO): In very severe cases, ECMO (extracorporeal membrane oxygenation), a life-support system or a heart-lung bypass machine may be needed to support the baby’s lungs and heart. If ECMO support is anticipated, coagulation studies and a head ultrasound should be done before cannulation.

Meconium aspiration syndrome prognosis

With prompt and appropriate treatment, most babies with meconium aspiration syndrome (MAS) recover without long-term problems 3. However, severe meconium aspiration syndrome (MAS) cases can be life-threatening. Nowadays, mortality in meconium aspiration syndrome (MAS) is close to 1.2 percent based on a large retrospective study in the United States 3. This is lower than the mortality reported in developing countries 23. In the 1960s and 1970s, mortality rates were in excess of 50% 24.

  1. RAPOPORT S, BUCHANAN DJ. The composition of Meconium; isolation of blood-group-specific polysaccharides; abnormal compositions of meconium in meconium ileus. Science. 1950 Aug 4;112(2901):150-3. doi: 10.1126/science.112.2901.150[↩]
  2. Matthews TG, Warshaw JB. Relevance of the gestational age distribution of meconium passage in utero. Pediatrics. 1979 Jul;64(1):30-1.[↩][↩][↩]
  3. Sayad E, Silva-Carmona M. Meconium Aspiration. [Updated 2023 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557425[↩][↩][↩][↩][↩]
  4. Skelly CL, Zulfiqar H, Sankararaman S. Meconium. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542240[↩]
  5. Singh A, Mittal M. Neonatal microbiome – a brief review. J Matern Fetal Neonatal Med. 2020 Nov;33(22):3841-3848. doi: 10.1080/14767058.2019.1583738[↩]
  6. Scholfield DW, Ram AD. The importance of recording first passage of meconium in neonates. BMJ. 2017 Mar 2;356:j711. doi: 10.1136/bmj.j711[↩]
  7. Clark DA. Times of first void and first stool in 500 newborns. Pediatrics. 1977 Oct;60(4):457-9.[↩]
  8. Arnoldi R, Leva E, Macchini F, Di Cesare A, Colnaghi M, Fumagalli M, Mosca F, Torricelli M. Delayed meconium passage in very low birth weight infants. Eur J Pediatr Surg. 2011 Dec;21(6):395-8. doi: 10.1055/s-0031-1291301[↩]
  9. Bekkali N, Hamers SL, Schipperus MR, Reitsma JB, Valerio PG, Van Toledo L, Benninga MA. Duration of meconium passage in preterm and term infants. Arch Dis Child Fetal Neonatal Ed. 2008 Sep;93(5):F376-9. doi: 10.1136/adc.2008.138024[↩]
  10. Wiswell TE, Tuggle JM, Turner BS. Meconium aspiration syndrome: have we made a difference? Pediatrics. 1990 May;85(5):715-21.[↩][↩]
  11. Whitfield JM, Charsha DS, Chiruvolu A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. Proc (Bayl Univ Med Cent). 2009 Apr;22(2):128-31. doi: 10.1080/08998280.2009.11928491[↩][↩][↩][↩]
  12. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, Simon WM, Weiner GM, Zaichkin JG. Part 13: Neonatal Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015 Nov 3;132(18 Suppl 2):S543-60. doi: 10.1161/CIR.0000000000000267[↩]
  13. Perlman JM, Wyllie J, Kattwinkel J, Wyckoff MH, Aziz K, Guinsburg R, Kim HS, Liley HG, Mildenhall L, Simon WM, Szyld E, Tamura M, Velaphi S; Neonatal Resuscitation Chapter Collaborators. Part 7: Neonatal Resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2015 Oct 20;132(16 Suppl 1):S204-41. doi: 10.1161/CIR.0000000000000276[↩]
  14. Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol. 2011 Apr;117(4):828-835. doi: 10.1097/AOG.0b013e3182117a26[↩]
  15. Saleh AM, Dudenhausen JW, Ahmed B. Increased rates of cesarean sections and large families: a potentially dangerous combination. J Perinat Med. 2017 Jul 26;45(5):517-521. doi: 10.1515/jpm-2016-0242[↩]
  16. Alexander GR, Hulsey TC, Robillard PY, De Caunes F, Papiernik E. Determinants of meconium-stained amniotic fluid in term pregnancies. J Perinatol. 1994 Jul-Aug;14(4):259-63.[↩]
  17. Abramovich DR, Gray ES. Physiologic fetal defecation in midpregnancy. Obstet Gynecol. 1982 Sep;60(3):294-6.[↩]
  18. Hooper SB, Harding R. Changes in lung liquid dynamics induced by prolonged fetal hypoxemia. J Appl Physiol (1985). 1990 Jul;69(1):127-35. doi: 10.1152/jappl.1990.69.1.127[↩]
  19. Ghidini A, Spong CY. Severe meconium aspiration syndrome is not caused by aspiration of meconium. Am J Obstet Gynecol. 2001 Oct;185(4):931-8. doi: 10.1067/mob.2001.116828[↩]
  20. Lee J, Romero R, Lee KA, Kim EN, Korzeniewski SJ, Chaemsaithong P, Yoon BH. Meconium aspiration syndrome: a role for fetal systemic inflammation. Am J Obstet Gynecol. 2016 Mar;214(3):366.e1-9. doi: 10.1016/j.ajog.2015.10.009[↩]
  21. Okazaki K, Kondo M, Kato M, Kakinuma R, Nishida A, Noda M, Taniguchi K, Kimura H. Serum cytokine and chemokine profiles in neonates with meconium aspiration syndrome. Pediatrics. 2008 Apr;121(4):e748-53. doi: 10.1542/peds.2007-1697[↩]
  22. Autilio C, Echaide M, Shankar-Aguilera S, Bragado R, Amidani D, Salomone F, Pérez-Gil J, De Luca D. Surfactant Injury in the Early Phase of Severe Meconium Aspiration Syndrome. Am J Respir Cell Mol Biol. 2020 Sep;63(3):327-337. doi: 10.1165/rcmb.2019-0413OC[↩]
  23. Singh BS, Clark RH, Powers RJ, Spitzer AR. Meconium aspiration syndrome remains a significant problem in the NICU: outcomes and treatment patterns in term neonates admitted for intensive care during a ten-year period. J Perinatol. 2009 Jul;29(7):497-503. doi: 10.1038/jp.2008.241[↩]
  24. Davis RO, Phillips JB, 3rd, Harris BA, Jr, Wilson ER, Huddleston JF. Fatal meconium aspiration syndrome occurring despite airway management considered appropriate. Am J Obstet Gynecol. 1985;151(6):731–736. doi: 10.1016/0002-9378(85)90506-x[↩]

you might also like

Health Jade