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At least 19 recordsLinked to original sources
PubMed1992

Meconium peritonitis: extrusion of meconium and different sonographical appearances in relation to the stage of the disease.

By chance, we had the opportunity to make serial sonographic observations of the extrusion of meconium in a case of meconium peritonitis. Inflammation leads to exudative processes and production of fluid (ascites) in the fetal abdomen. Sonography at that stage of the disease may lead to a misdiagnosis such as 'fetal ascites' or 'non-immune hydrops'. After bowel perforation and extrusion of meconium, the latter appears as a solitary mass inside fetal ascites or as disseminated echogenic masses distributed subdiaphragmatically or perihepatically. Within a couple of days, in most cases the echogenicity of the masses increases. Calcifications lead to distinct shadowing. These calcifications are often the only visible signs of a previous meconium peritonitis. Serial sonograms are essential for the management of pregnancies with meconium peritonitis. If the amount of fetal ascites does not increase and no signs of cardiovascular stagnation appear, no invasive intrauterine diagnostic and therapeutic steps are required. In none out of the nine cases was a cause found.

Adult↗
PubMed1975

Studies in meconium: disaccharidase activities in meconium from cystic fibrosis patients and controls.

Meconium ileus represents the earliest clinical manifestation of cystic fibrosis. The differences found in the composition and amount of protein, mucoprotein, mucopolysaccharides, and reducing sugars in meconium from newborns with cystic fibrosis might be of significance relative to the pathogenesis and early diagnosis of this disease. We studied the enzymatic activity of disaccharidases (lactase, sucrase, maltase, and palatinase) in meconium of infants with cystic fibrosis and controls. We found an increase in the specific activity of these enzymes in the meconium from infants with cystic fibrosis as compared to the specific activity in meconium from normal infants. The increase in the activities, expressed as micromols per gram of protein per minute was: lactase, 100 times higher; sucrase, 18 times; maltase, 4.8 times, and palatinase, 8.9 times.

Cystic Fibrosis↗
PubMed1979

Study of the oligosaccharide units from mucus glycoproteins of meconium from normal infants and from cases of cystic fibrosis with meconium ileus.

1. The mucus glycoproteins in meconium from normal infants and from infants having cystic fibrosis with meconium ileus have been studied. 2. Whereas normal meconium contained about 50% protein-bound carbohydrate, the meconium from cystic fibrosis contained only about 10%. 3. Glycopolypeptides were prepared from the mucus of glycoproteins. The oligosaccharide units from this material were released and fractionated. The fractions ranged widely in size and composition. 4. The fractions from cystic fibrosis specimens had a significantly higher content of fucose than those from normal specimens.

Carbohydrate Metabolism↗
PubMed1991

Intrapartum amnioinfusion for replacement of meconium-stained-amniotic-fluid to prevent meconium aspiration syndrome.

The presence of meconium-stained amniotic-fluid (MSAF) during labor in cephalic presentation is a potentially ominous sign of fetal distress and, a direct cause of meconium aspiration syndrome (MAS). The authors designed a new method of intrapartum amnioinfusion for replacement (IAR) of the MSAF with normal saline solution. A total of 177 parturients with MSAF were studied from July 1986 to January 1987. Seventy-three cases receiving IAR treatment were analysed and 104 cases treated routinely served as controls. The newborn infants receiving IAR treatment had a significantly lower incidence of neonatal asphyxia (P less than 0.001) and MAS (P less than 0.05). No neonatal death occurred in the treated group; whereas, three infants died in the controls. There was no significant difference in puerperal morbidity between these two groups. The results of this study suggest that IAR might be a hopeful and effective treatment for parturients with MSAF in reducing the incidence of MAS.

Amnion↗
PubMed1991

Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal Hirschsprung's disease. A scoring system.

Abdominal plain films of 133 neonates, with 82 cases of meconium plug syndrome (MPS), 27 cases of meconium ileus (MI) and 24 cases of neonatal Hirschsprung's disease (HD), were reviewed to assess the value of such radiographs for diagnosis. The radiographs were examined according to a list of 11 parameters. By using multivariate discriminant analysis, it appeared that 4 parameters i.e. dilatation of bowel loops, varying loop calibre, fluid levels and colonic gas were most important in discriminating among the three disorders. For each parameter the weight (in points) was derived. To classify patients, three group-scores had to be calculated: the group-score with the largest value indicated the most likely disorder. So in 99%, 88% and 63% of MPS, HD and MI, respectively, an accurate diagnosis could be predicted. The overall diagnostic accuracy was 89%. Such a diagnosis can be a sound basis for further investigation.

Dilatation, Pathologic↗
PubMed1989

Meconium aspiration syndrome: intrapartum and neonatal attributes.

To identify the fetus and newborn at risk for meconium aspiration syndrome the perinatal characteristics of 238 infants delivered through meconium-stained amniotic fluid were prospectively examined. All infants with meconium-stained amniotic fluid were routinely suctioned with a DeLee apparatus before tracheal intubation and suctioning. The type and presence of meconium in the trachea, neonatal breathing before intubation, and Apgar scores were recorded in the delivery room. Intrapartum fetal monitoring data were collected for 80% (190/238) of the mothers and umbilical artery pH for 74% (177/238) of the newborns. Despite suctioning with a DeLee apparatus and endotracheal suctioning, meconium was present in the trachea in 87/238 (37%) and meconium aspiration syndrome developed in 22 (9.2%). A total of 73% of newborns who had meconium aspiration syndrome were delivered through thick meconium. Thick meconium, the presence of fetal tachycardia, and absence of intrapartum fetal cardiac accelerations identified the fetus at high risk for meconium aspiration syndrome. The presence of these monitoring findings and thick meconium should alert obstetricians to the possibility of a fetus that requires intervention. Low umbilical artery pH, Apgar scores less than 5, and meconium in the trachea further characterized the newborn at high risk for meconium aspiration syndrome. The combination of these findings may best identify the infant delivered through meconium-stained amniotic fluid who requires close observation for meconium aspiration syndrome.

Amniotic Fluid↗
PubMed1992

Does DeLee suction at the perineum prevent meconium aspiration syndrome?

OBJECTIVE: We attempted to determine the impact of "early" (before delivery of the chest) oronasopharyngeal DeLee suctioning at the perineum in the prevention of meconium aspiration syndrome and to confirm that meconium aspiration syndrome is a postnatal event. STUDY DESIGN: We compared infants with meconium-stained fluid who underwent "early" oronasopharyngeal DeLee suctioning with a similar group of infants whose airways were suctioned "late" (after chest delivery). Practicing obstetricians did not know the study was being conducted by the pediatric staff, and an independent observer documented whether obstetricians performed "early" or "late" oronasopharyngeal DeLee suctioning. Immediate postnatal tracheal suctioning was performed in both groups. The study was conducted in a private tertiary care center averaging 5800 deliveries annually. A consecutive sample of 438 infants with meconium-stained fluid was analyzed. Of these infants, 221 received "early" oronasopharyngeal DeLee suctioning, while 217 infants were suctioned "late". RESULTS: Of the 438 infants with meconium-stained fluid, meconium aspiration syndrome developed in 38 (9%). These infants had higher rates of fetal distress (i.e., abnormal fetal heart rates) and lower Apgar scores (< or = 6) than infants without meconium aspiration syndrome (58% vs 17% and 65% vs 13%, respectively; p < 0.001). Forty-five percent of the infants with meconium aspiration syndrome had renal failure during the first 20 hours of life. In spite of "early" oronasopharyngeal DeLee suctioning, 53% of the infants in this group had meconium below the vocal cords and meconium aspiration syndrome developed in 7%. The time of oronasopharyngeal DeLee suctioning did not affect the rate of meconium aspiration syndrome or the presence of meconium below the vocal cords. CONCLUSIONS: We concluded that "early" oronasopharyngeal DeLee suctioning at the perineum does not affect the rate of meconium aspiration syndrome. We speculate that meconium aspiration syndrome is predominantly an intrauterine event associated with fetal distress and that meconium in the airways is merely a "marker" of previous fetal hypoxia.

Chi-Square Distribution↗
PubMed1990

Objective assessment of meconium content of amniotic fluid.

The amount of meconium in amniotic fluid is subjectively estimated by visual inspection and classified as thin (light), moderate, or thick (heavy). This estimate may be important for assessing the neonatal risk of perinatal asphyxia and meconium aspiration syndrome. This study reports on the "meconium-crit," a simple, rapid, inexpensive, and reproducible method of quantifying meconium concentration in amniotic fluid. The purpose of the study was to determine the relationship between the meconium-crit and meconium concentration. Specimens were prepared by placing 3.0 g of fresh neonatal meconium into clear amniotic fluid and vortexing for 15 minutes to obtain a stock solution of 15.0 g meconium/100 mL amniotic fluid. Stock solutions were then diluted with clear amniotic fluid to obtain concentrations of 10.0, 7.5, 5.0, 3.0, and 1.5 g/100 mL. One-tenth milliliter of the amniotic fluid/meconium mixture was drawn into a standard hematocrit tube and centrifuged. The meconium-crit was then measured directly as with a hematocrit. Regression analysis indicated that meconium-crit values were linearly related to meconium concentration (r = 0.901-0.995). This method provides a reproducible means of quantifying meconium in amniotic fluid.

Amniotic Fluid↗
PubMed1992

An assessment of the use of meconium alone as an indication for fetal blood sampling.

OBJECTIVE: To assess the validity of meconium as an indication for fetal blood sampling. METHODS: The study design was a prospective observational study in a teaching hospital. Fetal blood samples were taken from 401 women. One hundred sixty-five patients had meconium-stained amniotic fluid (77 of whom had no cardiotocographic abnormalities). In the remaining 236 patients, the indication for fetal blood sampling was cardiotocographic abnormalities without meconium. The main outcome measures were the values of pH and base excess obtained at fetal blood sampling, 1-minute Apgar scores, and umbilical artery pH values. RESULTS: Patients with meconium alone as an indication for fetal blood sampling had higher scalp sample pH values (P < .001) and 1-minute Apgar scores (P < .01) than laboring patients with both meconium and cardiotocographic abnormalities. The patients with meconium alone had higher scalp pH values than patients with cardiotocographic abnormalities but no meconium (P < .001). In only two patients with meconium alone was a fetal scalp pH less than 7.20 (both infants had good Apgar scores at delivery). However, when cardiotocographic abnormalities were present, the finding of meconium was significant, resulting in lower 1-minute Apgar scores (P < .01) despite a lack of difference in fetal blood sample pH values. CONCLUSION: In the absence of cardiotocographic abnormalities, meconium is not an indication for fetal blood sampling.

Adult↗
PubMed1992

Meconium aspiration syndrome: reflections on a murky subject.

Meconium-stained amniotic fluid occurs in approximately 12% of live births. In approximately one third of these infants meconium is present below the vocal cords. However, meconium aspiration syndrome develops in only 2 of every 1000 live-born infants. Ninety-five percent of infants with inhaled meconium clear the lungs spontaneously. Recent investigations have suggested that a reexamination of our assumptions about the etiology of meconium aspiration syndrome is in order. Several authors have provided evidence that support the hypothesis that it is not the inhaled meconium which produces the primary pathologic condition of meconium aspiration syndrome but rather it is fetal asphyxia that is the etiologic agent. Asphyxia in utero produces pulmonary vasospasm and hyperreactivity of the pulmonary vessels. With severe asphyxia the fetal lungs undergo pulmonary vascular damage with pulmonary hypertension. The damaged lungs are then unable to clear the meconium. In the most severe cases there is right-to-left shunting and persistent fetal circulation with subsequent fetal death. The incidence of meconium aspiration may thus be essentially unaffected by current obstetric and pediatric interventions at birth. For the asphyxiated or distressed infant we recommend suctioning at birth and tracheal intubation. In the healthy fetus observation may be sufficient.

Asphyxia Neonatorum↗
PubMed1992

Prophylactic amnioinfusion improves outcome of pregnancy complicated by thick meconium and oligohydramnios.

OBJECTIVE: The null hypothesis is that the use of intrapartum amnioinfusion in labors complicated by the presence of thick meconium and oligohydramnios will not decrease the incidence of fetal distress, cesarean delivery, meconium aspiration, or meconium aspiration syndrome. STUDY DESIGN: One hundred seventy term and postterm patients with thick meconium and oligohydramnios were randomly chosen to receive amnioinfusion or standard obstetric care without amnioinfusion. The frequency of fetal distress, cesarean section, meconium aspiration, and meconium aspiration syndrome were subject to chi 2 analysis, Student's t test, or Fisher's exact test. RESULTS: The rate of fetal distress was significantly reduced in the amnioinfusion group compared with controls (three of 85 vs 19 of 85, relative risk 0.15, 95% confidence interval 0.06 to 0.42). The rate of cesarean section for fetal distress was significantly reduced in the amnioinfusion group (two of 85 vs 17 of 85, relative risk 0.118, confidence interval 0.03 to 0.49). The rates of meconium aspiration (four of 85 vs 33 of 85, relative risk 0.12, confidence interval 0.0449 to 0.327) and meconium aspiration syndrome (0 of 85 vs five of 85, relative risk 0.09, confidence interval 0.009 to 0.872) were significantly reduced by amnioinfusion. CONCLUSIONS: Amnioinfusion improves the outcome in pregnancies complicated by thick meconium and oligohydramnios.

Amnion↗
PubMed1991

Meconium for drug testing.

Samples of meconium from 28 neonates born to women suspected of drug abuse were tested for drugs of abuse (ie, cocaine, morphine, codeine, and marijuana). In each case, testing of urine from the mother, the newborn, or both had been ordered by the attending physician because of suspected maternal drug abuse. Seventeen (61%) of 28 meconium samples tested positive; 28 (60%) of 47 urine samples were positive. Meconium test results were concordant with the results of maternal or newborn urine testing in 24 (86%) of the 28 cases. In three cases, meconium was positive for cocaine when newborn urine was negative; in one case, meconium was negative when maternal urine was positive for cocaine. Compared with the combination of maternal and newborn urine testing, meconium testing had an 82% positive predictive value (14/17) and a 91% negative predictive value (10/11). Collection of meconium is simpler and more reliable than collection of urine, and testing of meconium was easily incorporated into routine procedures at a busy commercial laboratory. Meconium is a useful sample for drug detection in newborns.

Cocaine↗
PubMed1992

Removing meconium from infant tracheae. What works best?

OBJECTIVE: At least nine mechanical devices are available for suctioning the tracheae of meconium-stained newborns. To our knowledge, the efficacy of these devices, as well as various suction pressures and patterns, has not been previously compared. We performed this investigation to assess these variables. DESIGN: Fourteen suction techniques (combinations of device, suction pressure, and suction intermittency) were evaluated sequentially in the trachea of each of 14 in vitro newborn piglets (1 to 4 days old); the order was randomized using a Latin square design. We chose three devices to compare: a meconium aspirator (Neotech Products Inc, Chatsworth, Calif), a hand pump (Res-Q-Vac, Repromed Systems Inc, New York, NY), and a 10F suction catheter (Superior Healthcare Group Inc, Cumberland, RI). Both the meconium aspirator and the hand pump were used with a 3.0-mm endotracheal tube. INTERVENTION: We instilled 0.8 mL of a homogeneous mixture of human meconium and saline (44 g of meconium per 100 mL of saline) in the trachea before applying each suction technique. The meconium aspirator and the suction catheter were each evaluated at three different vacuum pressures, -40, -80, and -150 mm Hg, using both continuous and interrupted suction. The hand pump was evaluated with one and two activations (one activation generates -100 cm H2O, according to the manufacturer). MEASUREMENTS AND RESULTS: The percentage of instilled meconium recovered was consistently greatest (P less than .001) with the meconium aspirator (mean, 88.9% at -150 mm Hg, 84.9% at -80 mm Hg, and 73.5% at -40 mm Hg), intermediate with the catheter (mean, 81.0% at -150 mm Hg, 73.2% at -80 mm Hg, and 67.5% at -40 mm Hg), and least for the hand pump (mean, 67.9% with one activation and 72.6% with two activations). Recovery was better with continuous suction (P = .02) and increasing pressure (P less than .001). CONCLUSIONS: Among the techniques compared, the meconium aspirator at -150 mm Hg, using continuous suction, performed best in this model. It is unknown, however, to what extent the tracheal mucosa may be affected by this degree of negative pressure.

Animals↗
PubMed1991

Inhibition of pulmonary surfactant function by meconium.

The pathophysiology of meconium aspiration is marked by lung hyperinflation because of airway obstruction, which is often followed by an acute pneumonitis with classic lung injury characteristics. Surfactant dysfunction may contribute to this latter pulmonary pathophysiology. We sought to determine to what extent meconium itself might contribute to a functional surfactant deficiency. Specimens of newborn infants' first meconium were collected and pooled. Serial dilutions of the meconium were then added to various concentrations of calf lung surfactant extract, a mixture with the surface properties of natural surfactant that is used clinically to treat neonatal respiratory distress syndrome, and the dynamic surface activity of these mixtures was studied with a pulsating bubble surfactometer. At surfactant concentrations of less than or equal to 1.5 mg/ml, even 6500-fold dilutions of meconium-inhibited surface tension lowering ability (10 +/- 2 mN/m vs 1 +/- 0.1 mN/m for controls, p less than 0.05). Moreover, this inhibitory activity resided in both the chloroform-soluble and the aqueous phases of meconium and appeared to be additive in nature. However, at sufficiently high concentrations of surfactant, even large amounts of meconium were unable to affect surface tension lowering properties. Thus meconium inhibits surfactant function in a manner that is dependent on the surfactant concentration, suggesting the possible utility of exogenous surfactant therapy in some cases of meconium aspiration.

Animals↗
PubMed1976

Maternal and postnatal hypermagnesemia and the meconium plug syndrome.

Thirty dated pregnant Srague-Dawley rats received IM MgSO4 (750 mg/kg/ X 5 days) until birth. Fifteen untreated pregnant Sprague-Dawley rats of similar gestation served as controls. A total of 453 rats were born. Ninety neonates (two from each of 45 liters) were randomly removed before suckling, sacrificed, and the water content of the meconium and serum magnesium determined. The remaining 363 bewborn rats were observed for delayed passage of meconium or abdominal distention. Hypermagnesemic (6.3 +/- 0.5 mg/100 ml) neonates had neither abdominal distention nor delayed passage of meconium. The water content of meconium in hypermagnesemic rats (84.7 +/- 4.2% and in untreated controls (85.5 +/- 3.8%) were statistically similar. Dated pregnant mongrel dogs were given magnesium sulfate by continuous intravenous infusion and by bolus intravenous injection. The water content of meconium, transit time, and basic electrical rhythm (BER) of treated neonates were similar to untreated neonatal controls. The water content of meconium, transit time, and BER of neonatal dogs made hypermagnesemic (12.0 +/- 1.2 mg/100 ml) in the postnatal period were similar tp untreated neonatal controls. In adult and newborn pupies, receiving a continuous intravenous magnesium sulfate infusion, deep tendon reflexes ceased at serum magnesium levels of 9.0-10.0 mg/100 ml, spontaneous respiration at 14.0-15.0 mg/100 ml, and BER was suppressed (transiently) at 20.0-25.0 mg/10 ml. These data suggest that high (sublethal) doses of MgSO4 in pregnant and newborn animals have little effect on BER, meconium transit time or water content of the neonates. No correlation between MgSO4 treatment and the meconium plug syndrome was observed in the experiments.

Animals↗
PubMed1992

Surfactant lavage in a piglet model of meconium aspiration syndrome.

Meconium aspiration continues to be a major cause of morbidity and mortality in newborn infants and is one of the most common indications for extracorporeal membrane oxygenation. Lab studies have suggested that meconium inactivates surfactant and displaces surfactant from the alveolar surface. A recent report has suggested a clinical role for surfactant therapy in human infants with meconium aspiration. We evaluated the effect of surfactant (Survanta) lavage on a piglet model of meconium aspiration. Meconium pneumonitis was created by administration of 4 mL/kg of a 20% slurry of human meconium via endotracheal tube. Twenty-four newborn piglets were then randomly assigned to one of three groups: 1) suction only (n = 7), 2) saline lavage (n = 5), or 3) surfactant lavage (n = 7). Five piglets were excluded from analysis due to death from pneumothorax during meconium administration (n = 3), death from pneumothorax during saline lavage (n = 1), and death from pneumothorax during surfactant lavage (n = 1). The surfactant group had a statistically significant (p less than 0.05) improvement in arterial to alveolar oxygen ratio gradient versus both control groups for the first 3 h. The oxygenation index was statistically significant versus the suction only group at 1, 3, and 4 h. Surfactant lavage of meconium aspiration in piglets results in short-term improvement of oxygenation and warrants further study.

Animals↗
PubMed1990

Efficacy of bulb versus DeLee suction at deliveries complicated by meconium stained amniotic fluid.

A combined obstetric-pediatric approach to the management of deliveries complicated by meconium-stained amniotic fluid has been recommended to decrease the incidence of meconium aspiration syndrome. Although pharyngeal suction with a DeLee catheter is generally recommended, many obstetricians prefer to use a bulb syringe for suction at the perineum. A thorough review of the literature reveals no prospective studies in humans comparing the two techniques. In the present study, these two techniques of pharyngeal suction were prospectively compared at deliveries complicated by meconium-stained amniotic fluid. Of the total 2874 deliveries, 127 (4%) were complicated by moderate or thickly meconium-stained amniotic fluid, and 107 of these were included in the study. There were 53 infants in the DeLee-suctioned group and 54 in the bulb-suctioned group. Of the 107 studied infants, four (4%) developed meconium aspiration syndrome, three in the DeLee group and one in the bulb group. There was no significant difference in the amount of meconium found below the vocal cords, comparing pharyngeal DeLee suction to bulb suction (0.22 cc versus 0.24 cc; p = NS). In conclusion, the data fail to support a significant difference in efficacy between bulb and DeLee suction in clearing the naso- and oropharynx of the neonate of meconium in cephalic-presenting vaginal or cesarean delivery.

Adult↗