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VentWorld Case Studies
BABY C: MECONIUM ASPIRATION (NEONATE)
Published July 27, 2000
William French and John Raber
Lakeland Community College, Kirtland, OH
www.lakeland.cc.oh.us/index.htm
Contents (click to jump directly to that section, or scroll down
to read the case)
INTRODUCTION
Baby C was a 31 week male neonate born vaginally to a 36 year old
mother. Birth weight was 1200 grams. The baby presented with meconium
in the oropharynx.
CASE PRESENTATION
Baby C was immediately intubated and suctioned for a large amount
of meconium. After suction, the baby was given 100% oxygen and his
respirations were supported. His 5 minute Apgar score was 5, with
acrocyanosis and grunting respirations. L/S ratio was 1.5:1
Once he was stable, he was extubated and placed in a oxyhood with
30% oxygen. After an hour, his clinical status deteriorated with
increasing respiratory distress noted. An arterial blood gas revealed
the following
| pH |
7.31 |
PaO2 |
46 mmHg |
| PaCO2 |
42 mmHg |
SaO2 |
78% |
| HCO3 |
18 mEq/L |
FIO2 |
0.30 (oxyhood) |
An hour later, his clinical status continued to deteriorate, with
a Silverman score of 10. Heart rate was 160 beats/minute, respiratory
rate was 72 breaths/minute with audible expiratory grunting. Arterial
blood pressure was 52/29 mmHg.
At this point he was placed on CPAP at 6 cmH2O and 80% oxygen.
ABGs taken after 30 minutes were:
| pH |
7.25 |
PaO2 |
44 mmHg |
| PaCO2 |
50 mmHg |
SaO2 |
77% |
| HCO3 |
21 mEq/L |
FIO2 |
0.80 |
Immediately after these ABGs were analyzed and reported, the baby
was placed on positive pressure ventilatory support using the Galileo
ventilator. Settings were: IMV mode, respiratory rate 40 breaths/minute,
peak inspiratory pressure (PIP) 20 cmH2O, PEEP 4 cmH2O, FiO2 80%.
Two hours later he was given 4.8 mL of Survanta (dose: 4mL/Kg).
His condition improved over the next several hours and within 12
hours after initiation of ventilatory support his FiO2 was weaned
down to 40%.
His condition continued to improve with no additional complications,
and he was discharged four weeks postpartum. Upon discharge he weighed
2000 grams.
DISCUSSION:
What might have caused the episode? Do you think the staff recognized
and managed the case appropriately? Post your thoughts or ask other
questions related to this case.
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