Fatal meconium aspiration in spite of appropriate perinatal airway management: pulmonary and placental evidence of prenatal disease.
OBJECTIVE
Our purpose was to summarize eight cases of fatal meconium aspiration syndrome where pathologic review showed evidence of chronic prenatal disease and to compare these findings with those of a group of control infants and fetuses who died of other causes.


METHODS
A 15-year retrospective chart review identified the infants who died of meconium aspiration within 48 hours of life and who also had autopsies performed. Neonatal pulmonary and available placental pathologic findings are described from these study infants and are compared with published norms and with autopsy results from a group of control infants and fetuses.


RESULTS
Seven of the eight study infants underwent suctioning of the trachea immediately after birth. In all eight cases the neonatal lungs demonstrated histologic evidence of significant hypoxic changes of a chronic nature with onset before birth. The available placentas showed variable but significant abnormalities that support a case for subacute or chronic in utero compromise.


CONCLUSIONS
As in other reports, there is evidence that meconium aspiration may be a prenatal rather than a postnatal disease. However, this is the first study that presents evidence on the basis of both pulmonary and placental pathologic findings and reinforces the importance of placental examinations in complicated pregnancies.
Thureen
P J
PJ
Department of Pediatrics, University of Colorado Health Sciences Center, Denver, USA.
Hall
D M
DM
Hoffenberg
A
A
Tyson
R W
RW
D001980:Bronchi / Q000473:pathology; D005260:Female; D005311:Fetal Hypoxia / Q000150:complications; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications; D007231:Infant, Newborn; D008168:Lung / Q000473:pathology; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D010920:Placenta / Q000098:blood supply / Q000473:pathology; D011247:Pregnancy; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies; D013396:Suction; D014132:Trachea; D014599:Uterus / Q000098:blood supply