Meconium


Article Author:
Christy Skelly
Hassam Zulfiqar


Article Editor:
Senthilkumar Sankararaman


Editors In Chief:
David Wood
Andrew Wilt
Hajira Basit


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
7/29/2019 7:06:21 PM

Definition/Introduction

Meconium is the initial substance present in the intestines of the developing fetus and constitutes the first bowel movement of the newborn. Meconium can be green, brown, or yellow.[1] Term healthy neonates pass meconium between 24 to 48 hours following birth.[2][3] Preterm infants typically exhibit delayed passage.[4][5]

Issues of Concern

The presence of meconium-stained amniotic fluid is about 12-20% of deliveries and is much higher in post-dated births (up to 40%).[6][7][8] In-utero passage of meconium may indicate normal gastrointestinal maturation or more concerningly it may be a sign of acute or chronic fetal hypoxia.[6][7][8] Some of the conditions associated with meconium passage in-utero include placental insufficiency, preeclampsia, oligohydramnios, peripartum infections, and certain maternal drugs such as cocaine.[6][7][8] Babies born through a meconium-stained amniotic fluid are at higher risk of development of adverse events such as perinatal asphyxia and respiratory distress.[6][8] The accidental inhalation of meconium in-utero or during delivery can result in an adverse event for the infant, which is known as meconium aspiration syndrome.[9] This complication happens in about 3-9% of the babies delivered with meconium-stained amniotic fluid.[10] To reduce the risk of adverse consequences related to meconium-stained amniotic fluid, the American College of Obstetricians and Gynecologists 2014 guidelines recommend induction of labor at or after 42 weeks.[11] Similarly, induction of labor is to be considered between 41- 42 weeks of gestation.[11] In-utero passage of meconium before 32 weeks of gestation is rare, and in preterm babies, meconium-stained amniotic fluid may indicate chorioamnionitis, fetal sepsis (e.g., listeriosis) or in-utero cord compression.[12][13][6][8]

Clinical Significance

The passage of meconium within 24-48 hours after birth indicates that the intestines of the newborn are intact and patent.[14] This assessment is important for the initial newborn examination.[15][16] Failure to pass meconium beyond 48 hours in term neonates may indicate disease or obstruction of the infant's bowel.[17] The diagnostic differential for the delayed passage of meconium includes Hirschsprung disease, meconium plug syndrome, meconium ileus, anorectal malformations, small left colon syndrome, and intestinal atresias.[18] Hypothyroidism, sepsis, and electrolyte abnormalities (hypercalcemia, hypokalemia), and maternal medications (magnesium sulfate, illicit drugs) can also delay the passage of meconium.[18][5][12]

Nursing Actions and Interventions

In the event of the rupture of the fetal membranes, the nurse should assess the color of the amniotic fluid. Amniotic fluid should be clear, or straw tinged with small vernix particles in the fluid.[19] Brown or green staining of the fluid indicates the passage of meconium. Because the fetus swallows amniotic fluid in utero, meconium can be present in the infant's oropharynx at delivery.[20] During delivery, if meconium-stained amniotic fluid is noted, a neonatal resuscitation team should be promptly involved.

Traditionally, during labor, if meconium-stained amniotic fluid is encountered, an intrapartum suctioning of airways was done.[21] Latest guidelines recommend changing these practices quoting that these procedures are of unknown benefit and may be even harmful.[21][22][23] In the updated 2015 American Heart Association/American Academy of Pediatrics guidelines (AHA/AAP), routine intrapartum suctioning of the airways before the delivery of the shoulders is not recommended.[22][23] 

If the infant is vigorous with good muscle tone and respiratory efforts, further newborn care could be provided in the delivery room.[22] Routine suctioning of the meconium-stained fluid from the oropharynx is not recommended in these infants. However, if the airway is obstructed, then the airway clearance with suctioning of the meconium is recommended.[24] Close monitoring in the newborn nursery is warranted.

If the infant is not vigorous with poor neurological tone, insufficient breathing efforts, and bradycardia (heart rate <100 beats/minute), routine postnatal suctioning of the airways was widely practiced in the past to decrease the possibility of development of meconium aspiration syndrome.[21] The 2015 AHA/AAP guidelines do not recommend this practice and rather recommend immediate appropriate management to support ventilation and oxygenation, such as commencing positive pressure ventilation.[22][23] Interventions such as endotracheal intubation for positive pressure ventilation may be required in severe instances, and a prompt transfer to the neonatal intensive care unit for further management may be needed.[22] Airway clearance with suctioning of the meconium is recommended if the airway is obstructed.[24] The 2015 AHA/AAP guidelines emphasize on following the same resuscitation steps for infants with a meconium-stained amniotic fluid similar to those infants with clear fluid.[23] 

Nursing Monitoring

During labor, the assessment of the amniotic fluid color can determine if the infant is at risk for amniotic inhalation upon birth. If the meconium-stained amniotic fluid is noted, a neonatal resuscitation team should be involved. In places with limited perinatal resources, an amnioinfusion could be tried, but the benefits of this procedure are unclear.[25] Latest guidelines emphasize on following the same resuscitation measures for infants with a meconium-stained amniotic fluid similar to those infants with clear fluid.[23] The assessment of respirations, color, and signs of respiratory distress (grunting, nasal flaring, intercostal retractions, and tachypnea) are necessary after birth. Assessment for passage of meconium, which usually occurs during the first twenty-four hours of life, is part of the initial newborn examination and indicates an unobstructed gastrointestinal tract with a patent anus.[26][27][28]


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    Image courtesy Dr Chaigasame
Attributed To: Image courtesy Dr Chaigasame

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Meconium - Questions

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A nurse triages a 24-year-old pregnant woman in the emergency department. The patient is a GTPAL (Gravida-Term-Preterm-Abortions-Living) of 1-2-3-0-1 with the following vital signs: temperature 37.2 degree Celsius, pulse 84/min, respiratory rate 24/min, and blood pressure 130/82 mm Hg. She is currently 38.4 weeks pregnant. She has not had any high-risk factors in this pregnancy. She reports contractions for the past 2 hours, which are about 5 minutes apart. The nurse notices meconium-stained amniotic fluid on the patient's garments. Which of the following is the next best step in the management of this patient?



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A 24-year-old patient who is gravida-term-preterm-abortions-living children (GTPAL ) of 2-1-0-0-1, with vital signs of temperature 38.0 degree Celsius, pulse rate 98/min, respiratory rate 22/min, and blood pressure of 128/78 mm Hg, has just vaginally delivered a viable infant after a 12-hour labor. Prenatal screening includes group B streptococcus negative, hepatitis B negative, and Rh-positive, and MMR (measles, mumps, and rubella) immune. There was meconium staining of the amniotic fluid. Which of the following is consistent with a meconium-related complication seen in newborns?



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A term neonate is born by an emergency cesarean section due to maternal eclampsia. The mother received magnesium sulfate before delivery. The APGAR score is 7 and 9 at 1 and 5 minutes, respectively. She is breastfed and nursed well. The baby passed meconium at 60 hours of life. Vitals signs show a heart rate of 110/min, blood pressure 80/40 mm Hg, respiratory rate of 50/minute, and capillary refill of 2 seconds. Examination reveals a soft and non-tender abdomen. The rest of the physical examination, including perineal examination, is within normal limits. Which of the following is most likely responsible for the delayed passage of meconium?



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A 28-year-old gravida 2 para 1 is in labor. Her vital signs are temperature 37.4 Celsius, pulse 82/min, respiratory rate 20/min, and blood pressure 135/82 mmHg. The client has been laboring for eight hours and is 7 centimeters dilated and 80 percent effaced. The infant is at a plus 1 station. There is a gush of brown fluid with a contraction. The fetal heart rate is 130-140 beats per minute with no decelerations and minimal variability. The contractions have a frequency of three minutes and a duration of seventy seconds. Which of the following is the next best step in the management of this patient?



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A pregnant mother was admitted to the labor unit at 29 weeks gestational age with rupture of membranes for more than 24 hours duration. Fetal heart rate was 160/min. Amniotic fluid was found to be meconium stained. Mother also had a fever with a temperature of 38 C. An emergency C-section was done, and a preterm baby boy was delivered. The baby appears to be floppy, with poor respiratory efforts. The neonatal team resuscitates him with endotracheal intubation and positive pressure ventilation. He is admitted to the neonatal intensive care unit. Complete blood counts reveals hemoglobin of 17 g/dL, a total leucocyte count of 20,000 cells/microL (neutrophils 80%, lymphocytes 18%, and monocytes 2%), platelets of 100,000/microL. C- reactive protein is 3 mg/dL. A chest x-ray shows bilateral reticulonodular opacities. Which of the following is the most likely etiology for the presentation of this newborn?



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Meconium - References

References

Poggi SH,Ghidini A, Pathophysiology of meconium passage into the amniotic fluid. Early human development. 2009 Oct;     [PubMed]
Vargas MG,Miguel-Sardaneta ML,Rosas-Téllez M,Pereira-Reyes D,Justo-Janeiro JM, Neonatal Intestinal Obstruction Syndrome. Pediatric annals. 2018 May 1;     [PubMed]
Singh A,Mittal M, Neonatal microbiome - a brief review. The journal of maternal-fetal     [PubMed]
Chou YC,Chang WT, Prenatal Diagnosis of Anal Atresia - A Case Report. Journal of medical ultrasound. 2017 Jul-Sep;     [PubMed]
Enríquez Zarabozo E,Núñez Núñez R,Ayuso Velasco R,Vargas Muñoz I,Fernández de Mera JJ,Blesa Sánchez E, [Anorectal manometry in the neonatal diagnosis of Hirschsprung's disease]. Cirugia pediatrica : organo oficial de la Sociedad Espanola de Cirugia Pediatrica. 2010 Jan;     [PubMed]
Stanyer R,Hopper H, Is the incorporation of the newborn examination in the pre-registration curriculum acceptable in clinical practice? A qualitative study. Nurse education in practice. 2019 Feb;     [PubMed]
Wosenu L,Worku AG,Teshome DF,Gelagay AA, Determinants of birth asphyxia among live birth newborns in University of Gondar referral hospital, northwest Ethiopia: A case-control study. PloS one. 2018;     [PubMed]
Aldhafeeri FM,Aldhafiri FM,Bamehriz M,Al-Wassia H, Have the 2015 Neonatal Resuscitation Program Guidelines changed the management and outcome of infants born through meconium-stained amniotic fluid? Annals of Saudi medicine. 2019 Mar-Apr;     [PubMed]
Okoro PE,Enyindah CE, Time of passage of First Stool in Newborns in a Tertiary Health Facility in Southern Nigeria. Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society. 2013 Jan;     [PubMed]
Solaz-García AJ,Segovia-Navarro L,Rodríguez de Dios-Benlloch JL,Benavent-Taengua L,Castilla-Rodríguez DY,Company-Morenza MA, Prevention of meconium obstruction in very low birth weight preterm infants. Enfermeria intensiva. 2019 Apr - Jun;     [PubMed]
Singh AK,Pandey A,Rawat J,Singh S,Wakhlu A,Kureel SN, Management Strategy of Meconium Ileus-Outcome Analysis. Journal of Indian Association of Pediatric Surgeons. 2019 Apr-Jun;     [PubMed]
Chettri S,Bhat BV,Adhisivam B, Current Concepts in the Management of Meconium Aspiration Syndrome. Indian journal of pediatrics. 2016 Oct;     [PubMed]
Scholfield DW,Ram AD, The importance of recording first passage of meconium in neonates. BMJ (Clinical research ed.). 2017 Mar 2     [PubMed]
Clark DA, Times of first void and first stool in 500 newborns. Pediatrics. 1977 Oct     [PubMed]
Arnoldi R,Leva E,Macchini F,Di Cesare A,Colnaghi M,Fumagalli M,Mosca F,Torricelli M, Delayed meconium passage in very low birth weight infants. European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 2011 Dec     [PubMed]
Bekkali N,Hamers SL,Schipperus MR,Reitsma JB,Valerio PG,Van Toledo L,Benninga MA, Duration of meconium passage in preterm and term infants. Archives of disease in childhood. Fetal and neonatal edition. 2008 Sep     [PubMed]
Loening-Baucke V,Kimura K, Failure to pass meconium: diagnosing neonatal intestinal obstruction. American family physician. 1999 Nov 1     [PubMed]
Mundhra R,Agarwal M, Fetal outcome in meconium stained deliveries. Journal of clinical and diagnostic research : JCDR. 2013 Dec     [PubMed]
Shaikh EM,Mehmood S,Shaikh MA, Neonatal outcome in meconium stained amniotic fluid-one year experience. JPMA. The Journal of the Pakistan Medical Association. 2010 Sep     [PubMed]
Monen L,Hasaart TH,Kuppens SM, The aetiology of meconium-stained amniotic fluid: pathologic hypoxia or physiologic foetal ripening? (Review). Early human development. 2014 Jul     [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]
    [PubMed]

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