title: Fatal meconium aspiration syndrome occurring despite airway management considered appropriate.
abstract: A combined obstetric-pediatric approach to tracheal toilet is said to prevent serious cases of the potentially fatal meconium aspiration syndrome. After delivery of the head a DeLee trap is used to suction the oropharynx and nasopharynx. Immediately following delivery, endotracheal suction is performed in an effort to remove any remaining meconium-stained amniotic fluid. Although routinely using this approach, we continue to have occasional cases of fatal meconium aspiration syndrome. Therefore, we reviewed the outcome of infants born through meconium-stained fluid. During a 5-year period, 1420 (15%) of 9299 live-born infants had meconium-stained fluid. Thirty (2.1%) of these 1420 developed meconium aspiration syndrome and 12 (40%) died; eight received a postmortem examination. Four had unequivocal evidence of meconium aspiration, two had large numbers of intra-alveolar squamous cells, and two had no evidence of aspiration. We conclude that aggressive airway management during and immediately after delivery does not always prevent fatal meconium aspiration syndrome.
mesh_terms: D000653:Amniotic Fluid / Q000166:cytology; D036861:Delivery, Obstetric / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008168:Lung / Q000473:pathology; D008470:Meconium / Q000166:cytology; D010547:Persistent Fetal Circulation Syndrome / Q000150:complications; D011015:Pneumonia, Aspiration / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D001261:Pulmonary Atelectasis / Q000150:complications; D012189:Retrospective Studies; D013396:Suction