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PubMed1991

Hyperechoic meconium in the third trimester fetus: an uncommon normal variant.

Fetal meconium is usually hypoechoic or isoechoic to adjacent abdominal structures on antenatal sonography. Hyperechoic meconium is associated with pathologic conditions, such as meconium ileus, meconium peritonitis, and anorectal malformations. The authors describe three third trimester fetuses with hyperechoic meconium and a normal outcome. Although a prospective study revealed that this finding is very uncommon, hyperechoic meconium can be a normal variant, particularly when it is seen as an isolated finding late in the third trimester.

Adolescent↗

PubMedDate not supplied

Meconium aspiration syndrome, parental atopy and asthma symptoms in children under two years old.

OBJECTIVE: To determine the association among meconium aspiration syndrome, parental atopy and asthma symptoms in children younger than two years. MATERIAL AND METHODS: One hundred thirty six children who had suffered meconium aspiration syndrome were followed from birth to they were two years old. CONTROL GROUP included 136 healthy children without meconium aspiration syndrome. RESULTS: Group of children with meconium aspiration syndrome: The average hospital stay in neonatal intensive care unit was of 5.91 +/- 4.44 days and were given 65.5 +/- 16.6 hours of oxygen. Prevalence of asthma symptoms during the last year was of 41.2%; 35.7% had family history of allergies (p = NS). The average age at the beginning of asthma symptoms was of 12.64 +/- 6.96 months; 78.6% of children were male. CONTROL GROUP: 30.9% had wheezing episodes during the last 12 months; 28.6% were male; 38.1% had family history of allergies (p = NS). The average age at the beginning of asthma symptoms was of 15.57 +/- 6.05 months. CONCLUSION: Aspiration of meconium seems to be an important risk factor of the early beginning of asthma symptoms in children younger than two years. Data shows that the prevalence of asthma symptoms was higher in case group than in control group. Asthma symptoms risk increases in children with aspiration meconium syndrome and family background of allergies.

Asthma↗

PubMed2006

[Inflammatory mediators and hematological parameters in cord blood in labor complicated by meconium-stained amniotic fluid].

OBJECTIVE: Meconium-stained amniotic fluid at term gestation is a predictor for adverse perinatal outcome and is associated with increased peripartum infections, independent of other risk factors. The aim of our study was to evaluate concentrations of inflammatory mediators (such as cytokine IL-6 and intracellular adhesion molecule ICAM-1) and values of hematological parameters of cord blood in presence or absence of meconium in amniotic fluid in term labor. MATERIAL AND METHODS: Cord blood samples were obtained from 66 term normal neonates immediately after birth, Soluble ICAM-1 and IL-6 concentrations were measured with ELISA R&D Systems kits. The umbilical blood specimen was analyzed using an automated hematology cell analyzer. Blood films were stained using May-Grünwald-Giemsa method. RESULTS: There were no difference in concentrations of ICAM-1 and IL-6 in cord blood in groups with or without meconium-stained amniotic fluid. The mean count of umbilical nucleated red blood cells and white blood cells was significantly higher in meconium group. There was no correlation between the cord blood hematological values and ICAM-1 or IL-6. There was also no correlation between IL-6 and ICAM-I and duration of labor. The mode of delivery influenced cord blood IL-6 levels. CONCLUSIONS: There was no influence of meconium-stained amniotic fluid on cord blood IL-6 and ICAM-1 levels. Changes in hematological parameters in cord blood in meconium passage can suggest either fetus hypoxia or infection. Significant differences of concentrations of fetal IL-6 were associated with the mode of delivery.

Amniotic Fluid↗

PubMed1991

The incidence of meconium-stained amniotic fluid from 1980 through 1986, by year and gestational age.

The annual incidence of meconium-stained amniotic fluid was analyzed for changes in a total obstetric sample of 45,115 singleton, vertex, liveborn infants over a 7-year study period. The incidence of meconium-stained amniotic fluid for the total obstetric population was calculated for each year of the study period. The sample was then stratified by estimated gestational age, and the incidence of meconium-stained amniotic fluid was calculated for each gestational age group. The incidence of meconium-stained amniotic fluid increased 40.9% over the study period, from 18.8% in 1980 to 26.5% in 1986 (P less than .001). This increase was found to be in a consistent linear trend (P less than .05). The incidence of meconium-stained amniotic fluid was also found to increase significantly in a linear trend as gestational age of the fetus increased. These findings lend support to both the maturational theory and the stress theory of meconium passage in utero.

Amniotic Fluid↗

PubMed1989

Experimental meconium aspiration in guinea pigs.

The effects of aspirated heavy human meconium and clear human amniotic fluid on newborn guinea pig lungs were compared with the changes these solutions induced in lungs subjected to acute asphyxiation. No specific meconium-induced chemical pneumonitis was observed. Histologic changes in the form of necrosis and infiltration of the lungs were similar in pups that aspirated meconium and those that aspirated clear amniotic fluid; the only difference was in the distribution of these changes, which could be explained by the different consistencies of the two solutions. In the lungs of newborn pups that were exposed to 120 minutes of maternal asphyxia, had pH below 7.10, and aspirated the above fluids, additional dominant changes appeared in the form of diffuse intra-alveolar hemorrhage and alveolar wall destruction. These histologic studies indicate that deeply aspirated meconium does not cause the pulmonary vascular changes considered characteristic of meconium aspiration syndrome. However, aspirated meconium did affect the vascular system of the asphyxiated lungs to a significant degree.

Animals↗

PubMed1987

The role of antepartum testing in the management of postterm pregnancies with heavy meconium in early labor.

The documented association between heavy meconium in early labor and increased perinatal morbidity and mortality has alerted physicians to the presence of a potential high-risk fetal condition and to the possible need for immediate fetal blood pH determination. The purpose of this study was to determine whether antepartum fetal assessment can predict whether a postterm fetus with heavy meconium in early labor is at low or high risk for an adverse perinatal outcome. Eight hundred thirty-nine postterm patients were followed with antepartum testing, consisting of twice-weekly fetal heart rate (FHR) testing and ultrasonic amniotic fluid volume estimation. Overall, patients with heavy meconium in early labor had a significantly greater frequency of fetal distress. However, when women with heavy meconium in early labor were separated according to their antepartum testing results, those with normal results were found to have no greater risk for fetal distress or perinatal morbidity than women with normal testing and subsequently clear amniotic fluid. These findings suggest that postterm patients with heavy meconium in early labor and normal antepartum testing can be managed in labor in the same manner as low-risk patients without meconium.

Amniotic Fluid↗

PubMed1987

Meconium ileus: a fifteen-year experience with forty-two neonates.

From 1969 to 1984, 42 neonates were managed for meconium ileus caused by cystic fibrosis. Simple, uncomplicated meconium ileus occurred in 24 infants (57%) and complicated meconium ileus occurred in 18 (43%). Meglumine diatrizoate (Gastrografin) enema completely relieved the obstruction in 13 patients with simple meconium ileus (54%) and caused colonic and rectal perforations in three (13%). Six operative procedures were used in 29 patients: double enterostomy (seven), resection with primary anastomosis (seven), Bishop-Koop enterostomy (seven), intraluminal lavage (four), colostomy (three), and Mikulicz enterostomy (one). Postoperative complications included malabsorptive diarrhea (nine), pneumonia (three), intestinal obstruction (two), total parenteral nutrition-catheter sepsis (two), and anastomotic leak (one). Infants managed nonoperatively by Gastrografin enema had a significantly shorter hospitalization (average, 15 days) than those undergoing operation for simple meconium ileus (54 days) and complicated meconium ileus (111 days). Postoperative survival rate was 100% with a late survival rate of 86%.

Cystic Fibrosis↗

PubMed1985

Monoclonal antibodies for carcinoembryonic antigen (CEA) as a model system: identification of two novel CEA-related antigens in meconium and colorectal carcinoma tissue by Western blots and differential immunoaffinity chromatography.

In a previous study, five monoclonal antibodies against the carcinoembryonic antigen (CEA) with different epitope specificities were delineated. One of these antibodies which exhibits a high affinity for CEA binds to different carcinoma tissues, to liver tissue, and to granulocytes. This antibody was selected for the immunoaffinity purification of CEA and related antigens from colorectal carcinoma tissue, from spleen tissues, from bile, and from meconium. After elution from the immunosorbent, the antigens were separated by SDS-PAGE, were transferred to nitrocellulose, and were incubated with the five different antibodies. Antibody T84.1 bound to the following antigens: 177 kD and 128 kD from colonic carcinoma, 81 kD from bile, 49 kD from spleen, as well as 165 kD and 100 kD from meconium. Two additional antibodies showed a similar binding pattern. The fourth antibody (CEA.11) bound to the 165 kD meconium antigen and to the two colorectal carcinoma antigens. The fifth antibody (T84.66) showed a strong reaction with the 177 kD colorectal carcinoma antigen and a faint reaction with a 183 kD antigen in meconium. As judged from m.w. and immunochemical properties, the 128 kD colorectal carcinoma antigen and the 100 kD meconium antigen are two novel CEA-related antigens. Because antibody CEA.11 did not bind to the 100 kD meconium antigen in Western blots, the 165 kD antigen could be eluted from a CEA.11 immunosorbent without contamination by the 100 kD antigen. Similarly, as predicted from the binding pattern in the Western blots, the two colorectal carcinoma antigens were separated from each other by a T84.66 immunosorbent.

Antibodies, Monoclonal↗

PubMed1983

Immunological heterogeneity of carcinoembryonic antigen: purification from meconium of an antigen related to carcinoembryonic antigen.

Two antigens cross-reactive with carcinoembryonic antigen (CEA) and distinct from the nonspecific cross-reacting antigen were identified in meconium by double immunodiffusion with a conventional goat anti-CEA antiserum. These two antigens together competitively inhibited cross-reacting antibodies against them in CEA radioimmunoassay and contributed to the measurement of meconium CEA levels which averaged 6 times higher than that determined with anti-CEA specific antibody. A purification method for one of these antigens, tentatively designated meconium antigen, is described and uses a combination of ethanol fractionation, ion-exchange and molecular sieve chromatography, and adsorption to an immunoadsorbent containing a cross-reactive murine monoclonal antibody to CEA. Preliminary characterization of the purified meconium antigen showed it to be a glycoprotein, migrating as an alpha-globulin and having a molecular size similar to that of CEA (Mr 185,000 versus 200,000). Antigenically, it lacks at least one determinant present on CEA and differs further from CEA by being weakly reactive with concanavalin A and resistant to proteolytic digestion with Pronase E. Although these properties of meconium antigen suggest that it may be nonspecific cross-reacting antigen 2, additional chemical and antigenic studies are required to establish its relationship to CEA and other CEA-related antigens in meconium.

Adenocarcinoma↗

PubMed1981

Suctioning of upper airway meconium in newborn infants.

To compare the efficacy of bulb and catheter suctioning of upper airway meconium in neonates, meconium labeled with technetium Tc 99m sulfur colloid was injected into the trachea and oropharynx of anesthetized kittens. Human birth conditions were simulated by an inflated blood pressure cuff around the thorax and abdomen of the animals and by partial degassing of the lungs before introduction of meconium. Distribution of meconium in the upper airway was determined by scintigraph. Catheter suction brought about a 43% decrease in radioactivity while there was only a 1% decrease after bulb suctioning. Meconium may persist in the trachea for more than 20 minutes after introduction, indicating the desirability of continued suctioning efforts in neonates with meconium aspiration syndrome. The relative safety of the two techniques was not assessed.

Airway Obstruction↗

PubMed1980

Intrauterine meconium aspiration syndrome.

A case of presumptive intrauterine meconium aspiration is reported in which the diagnosis was made on the basis of an unexplained intrauterine fetal tachycardia and the presence of severely meconium-stained amniotic fluid. The possible pathophysiology of intrauterine meconium aspiration is discussed with special attention to animal experimentation. The importance of an early diagnosis of this condition is stressed. The clinical management of such cases may change once the antenatal diagnosis of intrauterine meconium aspiration can be made with more certainty. In addition, the legal implications of a confirmed diagnosis of intrauterine meconium aspiration are discussed as meconium aspiration is considered presently to represent a largely preventable neonatal event.

Adolescent↗

PubMed1994

Detection of cocaine, norcocaine, and cocaethylene in the meconium of premature neonates.

Our objective was to investigate the methodologic detection of cocaine abuse during pregnancy by determining the viability of meconium analysis for cocaine and its metabolites using chromatographic procedures as an alternative to urine testing using enzyme multiplied immunoassay technique. Our design was as follows: meconium and urine were taken from 106 very low birthweight premature babies. Meconium analysis for cocaine and its metabolites using extraction and chromatographic analysis was compared with the criterion standard immunoassay testing for urine. The work was carried out at The University of Chicago Hospital, Department of Pediatrics and the University of Illinois at Chicago, Department of Pharmacodynamics. Our patients were very low birthweight, premature babies (mean birthweight 1109 g; mean gestational age 29.1 weeks). Gender was evenly divided between male and female. The outcome measures were as follows: two active metabolites, norcocaine and cocaethylene, were detected in the meconium, but not in the urine, of some of the neonates. Determination of cocaine exposure in the newborn influenced assignment of babies in research studies as well as psychosocial evaluation and subsequent treatment of the neonate. Our results were: of the 106 meconium samples analyzed, 21 (19.8%) were positive for cocaine (n = 19, 0.24-0.78 mg/kg), norcocaine (n = 7, 0.10-0.56 mg/kg), cocaethylene (n = 1, 0.12 mg/kg) or combinations thereof. Benzoylecgonine was not detected in any of the samples. Of the urine samples analyzed by immunoassay, only 8 (7.5%) were positive for cocaine metabolites. We conclude that meconium is a better sample than urine for determining cocaine exposure in utero.(ABSTRACT TRUNCATED AT 250 WORDS)

Chromatography, High Pressure Liquid↗

PubMed1993

The incidence of meconium-aspiration in Hawaii.

Meconium in the amniotic fluid was found in 2,633 obstetrical patients and meconium-aspiration occurred in 77 cases out of 14,527 deliveries. Although the incidence of meconium in the amniotic fluid increased significantly at 39 weeks, a corresponding significant increase in meconium-aspiration did not occur until 41 weeks gestation. All deaths associated with meconium, as well as 84% of the cases of severe meconium-aspiration syndrome, occurred in infants born of patients with oligohydramnios and a gestational age of 41 weeks or greater.

Gestational Age↗

PubMed1993

Management of meconium stained amniotic fluid: a team approach.

Passage of meconium in utero is a serious neonatal disorder carrying high morbidity and mortality. Role of planned team approach with aggressive intrapartum suctioning and intensive neonatal management was studied to evaluate its impact on neonatal morbidity and mortality. Meconium Stained Amniotic Fluid (MSAF) was found amongst 7.4% of all deliveries and among these 238 (10.5%) babies developed meconium aspiration syndrome (MAS). Ninety five per cent babies with MSAF were born at > 36 weeks of gestation and 76% were more than 2.5 kg. Passage of thick and thin meconium was seen in 44 and 56% respectively. Passage of thick meconium was significantly associated with severe asphyxia and carried a bad prognosis with increased risk of development of meconium aspiration syndrome, hypoxic schemic encephalopathy, seizures and pulmonary air leak syndrome. Aggressive team approach was responsible for lowering the mortality to 7.7%.

Birth Weight↗

PubMed1977

[Current status in the diagnosis and therapy of meconium ileus].

Meconium ileus is in most cases difficult to diagnose preoperatively; however, aganglionosis should be excluded in every case (rectal double-suction biopsy, manometry). In cases of uncomplicated meconium ileus (no perforation, no further intestinal obstructions) lysis of the meconium by a Gastrografin enema is tried first. In case of no relief, an intraoperative puncture of the bowel and Gastrografin instillation is performed. If there is no relief a small bowel resection is performed and a Bishop-Koop anastomosis or a chimney anastomosis established. A distinction must be made between meconium ileus, meconium disease, meconium plug syndrome, and curd obstruction. Results show a survival rate of 80%.

Humans↗

PubMed1998

Contemporary treatment options for meconium aspiration syndrome.

The presence of meconium in the respiratory tract causes atelectasis, hypoxemia, hypercapnia, persistent pulmonary hypertension, inflammatory changes, and surfactant inactivation. Prevention is the most important factor in the management of meconium aspiration syndrome and it includes both prenatal and postnatal care. Prenatal procedures include constant fetal heart rate monitoring during labor, examination of acid-base equilibrium in the capillary blood from the fetal scalp, and eventually amnioinfusion. Amnioinfusion is not a widely accepted care and further studies to confirm its benefits are required. Postnatal procedures include obligatory suction of the oral-pharyngeal cavity and nose before the first breath, and selective endotracheal suction only in depressed neonates or neonates born from thick meconium-stained amniotic fluid. Conventional therapy of meconium aspiration syndrome includes monitoring of vital functions, chest physiotherapy, site drainage, airway suction, oxygen supply, respiratory support, antibiotics, sedation, normal fluid balance and calories intake, and when indicated, agents stabilizing blood pressure and heart rate. New management methods of meconium aspiration syndrome, not recommended as standard procedures at present include high-frequency oscillatory or jet ventilation as a lifesaving therapy, the use of exogenous surfactant, surfactant lavage of the bronchial tree, liquid ventilation, and inhalation of nitric oxide. Extracorporeal membrane oxygenation is of considerable importance in the treatment of the most severe meconium aspiration syndrome, but its role is diminishing with the development of other therapeutic methods.

Humans↗

PubMed1998

HPLC detection of fetal blood in meconium: improved sensitivity compared with qualitative methods.

We describe an HPLC-based method for the detection and quantification of fetal hemoglobin in stools of newborns. The new procedure is an alternative to the classic qualitative test for adult hemoglobin in meconium based on the differential stability of hemoglobin species in dilute base (Apt test). The HPLC method, based on a commercial device for hemoglobin characterization (Bio-Rad Variant), readily separates fetal and adult hemoglobin from non-hemoglobin components of meconium. To validate the method, blood and meconium were mixed in various proportions and then prepared for analysis with extraction in saline. The HPLC method accurately identified hemoglobin species even when the blood constituted only 5 mL per 100 g of the meconium specimen, and nearly quantitative recovery of hemoglobin was obtained at a blood content of 20 mL per 100 g of the meconium. Analysis time was 6.5 min, and preparation of sample was simple. HPLC detection of fetal blood in stools or other specimens markedly improves detection/characterization of blood in meconium.

Chromatography, High Pressure Liquid↗

PubMed1998

Management of meconium-stained neonates.

We examined the use of a new scoring system for the meconium-stained infant, which was designed to help the neonatologist decide on the appropriate therapeutic approach in the delivery room. Eighty meconium-stained infants were scored for: presence of fetal distress; meconium quality; performance of nasopharyngeal suctioning before the first breath and clinical condition in the first minute of life. Management consisted of gentle oropharyngeal suctioning or intubation and tracheal suctioning. Clinical outcome was compared with that of 100 meconium-stained infants born a year earlier. All babies in the control group underwent laryngoscopy and 30% were subsequently intubated. Universal laryngoscopy was not performed in the study group, and only 22.5% of these infants were intubated. The clinical outcome of the studied babies was identical to that of the newborns treated by the standard procedure. The use of the meconium intubation score eliminated the need for universal delivery room laryngoscopy for meconium-stained infants and significantly reduced the number of intubations performed.

Journal Article↗