MECONIUM ASPIRATION SYNDROME ADMITTING HISTORY
A 4535-g (10-lb, 0-oz) boy was born 1 week late (at 41 weeks’ gestation) following a difficult delivery with meconium-stained amniotic fluid. The newborn was not breathing or crying immediately following birth. His Apgar scores at delivery were 4 and then 8. His oral cavity was suctioned, and clumps of meconium were removed, and he was taken to the neonatal intensive care unit (NICU) for further evaluation.
PHYSICAL EXAMINATION
The infant was getting stabilized, and PRN suctioning of the airways was being performed. In the neonatal intensive care unit, the baby appeared to be in mild respiratory distress. On observation, the baby demonstrated intercostal retractions and nasal flaring with all respirations. A mild, grunt-like cry was noted.
The baby’s vital signs were as follows: blood pressure 70/50, apical heart rate 140 bpm, respiratory rate 44/minute, and rectal temperature 37.1°C (98.8°F). Auscultation revealed bilateral coarse crackles and a chest x-ray was normal. The infant was placed on an FIO2 of 0.4 via an oxygen hood. Umbilical ABGs were as follows: pH 7.49, PaCO2 29 mm Hg, HCO3– 22 mEq/L, PaO2 59 mm Hg, and SaO2 92%.
Based on the above clinical data, how would you SOAP this patient? (SOAP 1)
2 DAYS AFTER DELIVERY
At this time, the baby was doing great. His breathing improved, and he responded well to the PRN suctioning and oxygen therapy. This was a great example of when things go well, and respiratory complications are limited. Newborns that do not respond to initial treatment of airway clearance therapy and oxygen therapy often require intubation and mechanical ventilation. In addition, the meconium frequently causes a ball-valve effect in the lungs resulting in hyperinflation in the lungs. On day 6, the newborn was discharged and went home with no complications.