Page 706 - Clinical Application of Mechanical Ventilation

672 Chapter 19

CASE 13: MECONIUM ASPIRATION/

PATENT DUCTUS ARTERIOSUS

INTRODuCTION

Long gestational age has A 22-year-old Caucasian primigravida mother gave birth to a 41-week-gestation
a higher incidence of meco- female. The pregnancy was uncomplicated and the mother received all scheduled
nium aspiration syndrome.
prenatal care. Following admission to the labor and delivery floor, the amniotic
membrane was ruptured, revealing grade III meconium-stained amniotic fluid. Due to
failure to progress past 6-cm dilation, a cesarean section was performed. The birth
weight was 3,840-gm (8.5 lb).
At delivery, the neonate presented as nonvigorous. There was no respiratory
effort, a heart rate of 75 beats/min, poor peripheral perfusion, and poor muscle
Visualization of the vocal
cords helps to determine tone. The vocal cords, stained green from meconium, were visualized, and the
if meconium is present in
the upper airway. If the neonate was intubated immediately with a size 3.5 endotracheal (ET) tube and
vocal cords are stained green, suctioned via meconium aspirator attached to the ET tube. A large amount of partic-
suction should be done prior
to the first breath so as to pre- ulate meconium was recovered. A second attempt at suctioning via the ET tube re-
vent or minimize meconium covered a small amount of meconium. Following the second intubation and suction,
aspiration.
the neonate initiated her first breath. Respirations were labored with the presence of
mild intercostal and substernal retractions, nasal flaring, and audible grunting.

Points for Discussion

1. What would be the next step in providing support to this neonate?

2. What are your concerns regarding her postresuscitative care?
The Apgar scores were 3 and 7 at 1 and 5 mins, respectively. They were scored as
shown below.

0 1 2 1 min 5 min

Heart rate None Slow Irregular Over 100 1 2

Respiratory Apnea Irregular shallow Gasping Yelling, crying 0 1
effort

Muscle tone Flaccid Some flexion of extremities Well-flexed 1 2

Reflex No response to Grimace Crying 0 1
stimulus

Color Pale blue Blue extremities Pink all over 1 1
Body pink

Total 3 7
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