VentWorld Case Studies
BABY C: MECONIUM ASPIRATION (NEONATE)
Published July 27, 2000
William French and John Raber
Lakeland Community College, Kirtland, OH
Contents (click to jump directly to that section, or scroll down
to read the case)
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.
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
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:
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
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.