Quote from HillaryC
Thanks again to everyone who responded. I'm seeing my friend next week, so I'll hopefully get more information. I hear what you all are saying about the meconium aspiration being the more likely culprit for such a rapid onset illness.
Are C-section babies more likely to have problems when there's meconium in the amniotic fluid (because their lungs don't get "squeezed")? Also, I've never understood this: what causes the baby to have a BM in utero? Does something bad have to be going on for the baby to have a BM, or does it just happen sometimes?
Thanks again to everyone. I'm fascinated with NICU. At some point I may have to give up on grown-up patients and join you guys!
My sincere condolences to your friend and her family. I can't imagine a more heartbreaking situation.
I agree with the others that the MAS and PPHN are far more likely causes of the baby's death than a pseudomonas infection. Pseudomonas is usually hospital acquired, a late onset infection. Babies who develop pseudomonas have usually been on long-term ventilation. I haven't been able to find any articles describing pseudomonas as a cause of infection at birth.
Babies can pass meconium in utero for a couple of reasons. At about 35-36 weeks gestation, meconium makes its way to the lower gi tract. From that point on, anything that causes the anal sphincter to lose tone can result in meconium being passed into the amniotic fluid. A period of hypoxia can cause loss of sphincter tone. This can result from temporary cord compression, temporary drop in mom's B/P, baby gripping the cord, etc. Also, in breech babies, sometimes gravity and the pressure of the baby's anus against the cervix is enough to cause the anus to dilate.
When the stool is passed, it mixes with the amniotic fluid that surrounds the baby. As the baby practices breathing movements, meconium stained fluid is drawn into the baby's upper airway. This is not a problem until the birth of the baby, when actual breathing movements draw this stained fluid into the lower respiratory tract, where it can cause a severe chemical pneumonia, and interfere with the respiratory and circulatory changes that normally occur at birth. This can result in persistent pulmonary hypertension, a life-threatening complication of meconium aspiration.
At birth, a nurse, respiratory therapist, or physician must immediately suction the meconium out of the baby's upper airway, then visualize the baby's vocal cords. If they are stained with meconium, the child is intubated and the lower airway is also thoroughly suctioned to remove as much meconium as possible. This procedure has been effective in significantly reducing the morbidity and mortality from meconium aspiration in newborns. I am sorry that it didn't help in your friend's case.