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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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