Neonatal Case #1

Case Presentation:

N.G. 41 wk EGA male delivered by repeat CS to a 23 y.o. G2 P1 woman at a community hospital. Pregnancy was reported to be uncomplicated and membranes were ruptured 9 hours prior to delivery. Infant delivered vaginally with low forceps. Apgars were 5/7. The infant delivered through thick particulate meconium and was suctioned on the perineum by the obstetrician. The infant required blow-by oxygen for approximately 25 minutes in the delivery room. The tracheal aspirate showed no meconium, but 8 ml of meconium stained fluid was suctioned from the stomach. Infant was placed in 40% hood oxygen, but his condition deteriorated over the next several hours. Initial CXR is shown. At 5 hours of life the infant was intubated and hand ventilated for ~30 minutes. The infant was placed on intermittent mechanical ventilation (26/4 x 30 x FiO2 1.0) by the transport team and transferred to LLUCH. On arrival at LLUCH, an ABG from the UAC was 7.22/58/36/18, BE -3.

Questions:

1. Based on the information, what is your diagnosis?
2. List three potential complications associated with this disease.
3. Is thin consistency MSAF more likely to enter the airways and cause MAS or other respiratory distress compared with thick consistency MSAF?
4. Do vigorous meconium-stained infants need to be intubated and suctioned in the delivery room?
5. If meconium is noted prior to or at the time of delivery, what is the recommended course of action?
6. What factors are involved in the pathophysiology of MAS?
7. What mechanisms of meconium aspiration into the lungs contribute to ventilatory failure, and what is the role of surfactant therapy in treatment?
8. List three nursing interventions that should be considered for this patient.
9. Which of the following therapies have been approved by the Food and Drug Administration (FDA) specifically for the management of MAS: (a)systemic corticosteroids, (b)exogenous surfactant (c)inhaled nitric oxide, (d)high frequency ventilation, (e) ECMO?

For additional help in answering these questions, please feel free to consult any neonatology textbook or visit the website: http://pedsccm.wustl.edu/All-Net/english/pulmpage/neon/mecasp.html