50 Years ago in The Journal of Pediatrics:
Meconium staining of newborn infants
Article Outline
Desmond M, Lindley JE, Moore J, and Brown CA. J Pediatr 1956;49:540-9
In this prospective, observational study, Desmond et al reported that meconium-stained amniotic fluid (MSAF) was present in 10.9% of 3865 consecutive deliveries in a high-risk population (the figure is similar to what can be currently expected). This incidence was higher than in previous reports in which MSAF had not always been recorded by obstetricians. They discuss at length the characteristics of meconium and various ways to recognize exposure to MSAF and duration of exposure in utero. They evaluated staining of the infant’s skin, umbilical cord, and nails, clinically and with a Wood lamp. The authors described an association of meconium with length of gestation, need for resuscitation, and higher morbidity and mortality rates, compared with infants born with clear amniotic fluid. There was no description of respiratory problems associated with meconium, which has been the key concern in the ensuing 50 years. Their reported mortality rate for infants exposed to MSAF (3.4%) is more than 10 times higher than currently, but quite similar to the 4% incidence of meconium aspiration syndrome (MAS).1 It is likely that 50 years ago, most infants with MAS died.
Recently, the focus has been placed in the physiology and management of MAS, which continues to be a disease with high mortality rates. An association of MAS with asphyxia and pulmonary hypertension has been demonstrated. Three large, randomized, controlled trials suggested that obstruction of the airway should no longer be considered the main problem for these infants (amnioinfusion to dilute thick MSAF,2 postnatal intubation, and suction of vigorous meconium-stained infants,3 or suction of the hypopharynx before the delivery of the shoulders,1 had no influence in the incidence, severity, and mortality rates of MAS). The latter two procedures are no longer recommended.4 The frequency of MSAF and MAS has been decreasing, probably due to fewer deliveries at >40 weeks’gestation and to an increase in cesarean deliveries.
This article quotes a previous publication (Eastman, 1950) describing a concept that is precise even today: “The presence of meconium is not in itself an indication for delivery but demands close watching of the fetal heart rate.”
References
- . Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet. 2004;364:597–602
- Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med. 2005;353:909–917
- Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics. 2000;105:1–7
- International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrics. 2006;117:e978–e988
PII: S0022-3476(06)00587-7
doi:10.1016/j.jpeds.2006.06.041
© 2006 Mosby, Inc. All rights reserved.
