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Review ArticleClinical Review

Meconium Aspiration Syndrome: Pathophysiology and Prevention

Mary Celeste Klingner and Jerry Kruse
The Journal of the American Board of Family Practice November 1999, 12 (6) 450-466; DOI: https://doi.org/10.3122/jabfm.12.6.450
Mary Celeste Klingner
From the Department of Family and Community Medicine, Southern Illinois University School of Medicine, Quincy Family Practice Program (MCK, JK), Quincy, Ill. Address reprint requests to Jerry Kruse, MD, MSPH, Quincy Family Practice Program, 2325 Elm Street, Quincy IL 62301
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Jerry Kruse
From the Department of Family and Community Medicine, Southern Illinois University School of Medicine, Quincy Family Practice Program (MCK, JK), Quincy, Ill. Address reprint requests to Jerry Kruse, MD, MSPH, Quincy Family Practice Program, 2325 Elm Street, Quincy IL 62301
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Abstract

Background: Despite the common occurrence of intrauterine meconium passage and resultant meconium aspiration syndrome (MAS), controversies regarding the pathophysiology and use of appropriate preventive strategies abound.

Methods: Databases from MEDLINE, MD Consult, and the Science Citation Index were searched from 1964 to the present to find relevant sources of information.

Results and Conclusions: Meconium passage occurs by three distinct mechanisms: (1) as a physiologic maturational event, (2) as a response to acute hypoxic events, and (3) as a response to chronic intrauterine hypoxia. Meconium passage might merely be a marker of chronic intrauterine hypoxia or can predispose to aspiration of meconium and resultant inflammatory pneumonitis, surfactant inactivation, and mechanical airway obstruction. Aspiration can occur in utero with fetal gasping, or after birth with the first breaths of life. Many cases of MAS can be prevented by the strategies addressed in this article, but some will occur despite appropriate preventive techniques. There is not enough evidence to support the use of amnioinfusion as a standard of care for all pregnancies complicated by meconium. Pharyngeal suctioning before delivery of the shoulders is an effective preventive intervention, as is the combination of pharyngeal suctioning followed by intubation and tracheal suctioning. Suctioning of the trachea may be done on a selective basis depending on fetal vigor and consistency of meconium.

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The Journal of the American Board of Family     Practice: 12 (6)
The Journal of the American Board of Family Practice
Vol. 12, Issue 6
1 Nov 1999
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Meconium Aspiration Syndrome: Pathophysiology and Prevention
Mary Celeste Klingner, Jerry Kruse
The Journal of the American Board of Family Practice Nov 1999, 12 (6) 450-466; DOI: 10.3122/jabfm.12.6.450

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Meconium Aspiration Syndrome: Pathophysiology and Prevention
Mary Celeste Klingner, Jerry Kruse
The Journal of the American Board of Family Practice Nov 1999, 12 (6) 450-466; DOI: 10.3122/jabfm.12.6.450
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