Handling the meconium-stained infant

Clinicians who care for infants in the delivery room or afterward must frequently manage many born through meconium-stained amniotic fluid (MSAF). Approximately 5% of infants born through MSAF develop meconium aspiration syndrome (MAS). This disorder can be severe in nature, with half or more of the affected children needing mechanical ventilation. It is frequently associated with pulmonary air leaks and the presence of persistent pulmonary hypertension. MAS is the most common disorder for which babies may be treated with extracorporeal life support. Various possibilities for preventing MAS exist during labor, parturition, and the first minutes of life. Proposed antenatal therapies include amnioinfusion; intrapartum maneuvers include oropharyngeal suctioning prior to delivery of the babies shoulders; the postnatal intervention of intubation for intratracheal suctioning should be reserved for the non-vigorous meconium-stained infant.