MECONIUM ASPIRATION SYNDROME

MAS can happen before, during, or after labor and delivery when a newborn inhales (or aspirates) a mixture of meconium and amniotic fluid (the fluid in which the baby floats inside the amniotic sac). Meconium is the baby's first feces, or poop, which is sticky, thick, and dark green and is typically passed in the womb during early pregnancy and again in the first few days after birth.

Meconium aspiration syndrome involves aspiration of meconium through the trachea into the bronchial tree, sometimes down to the alveoli. Three classes of alveoli are described: (1) those not ventilated due to complete proximal obstruction (atelectatic) (2) those with partial meconium obstruction (3) those with no proximal obstruction. Alveoli with partial meconium obstruction are thought to trap air because of a ball-valve mechanism by which gas reaches the alveoli on inflation but is trapped secondary to reduced airway diameter during expiration. It is challenging to oxygenate babies with meconium aspiration syndrome, because the alveoli where gas trapping occurs may rupture, leading to air leak. Also, meconium in the alveoli may deactivate surfactant.

The inhaled meconium can partially or completely block the baby's airways. Although air can flow past the meconium trapped in the baby's airways as the baby breathes in, the meconium becomes trapped in the airways when the baby breathes out. And so, the inhaled meconium irritates the baby's airways and makes it difficult to breathe.

MAS can affect the baby's breathing in a number of ways, including chemical irritation to the lung tissue, airway obstruction by a meconium plug, infection, and the inactivation of surfactant by the meconium (surfactant is a natural substance that helps the lungs expand properly).

The severity of MAS depends on the amount of meconium the baby inhales as well as underlying conditions, such as infections within the uterus or postmaturity (when a baby is overdue, or more than 40 weeks' gestational age). Generally, the more meconium a baby inhales, the more serious the condition.

Normally, fluid is moved in and out of only the trachea (the upper portion of the airway) when there's breathing activity in the fetus. Meconium can be inhaled into the lungs when the baby gasps while still in the womb or during the initial gasping breaths after delivery. This gasping typically happens when there has been a problem (i.e., an infection or compression of the umbilical cord) that causes the baby to have difficulty getting enough oxygen in the womb.