In meconium aspiration syndrome, what management step is recommended for non-vigorous infants?

• A. Endotracheal suctioning
• B. Antibiotics only
• C. Supplemental oxygen alone
• D. Chest physiotherapy only

Answer: (A)

In meconium aspiration syndrome, clearing the airway is the top priority for infants who are non-vigorous at birth, because thick meconium can obstruct the trachea and bronchi and trigger inflammation that worsens gas exchange. The most effective way to remove that material is endotracheal suctioning, which allows direct removal of meconium from the lower airways before or during initial ventilation. This airway clearance can rapidly improve ventilation and oxygenation by reducing physical obstruction and the inflammatory load in the lungs.

Oxygen support is important, but it does not clear the blockage caused by meconium. Antibiotics aren’t routinely used as the sole therapy since MAS is not an infection, unless there’s a suspicion or evidence of sepsis. Chest physiotherapy alone hasn’t shown reliable benefit in this context and doesn’t address the primary issue of airway obstruction from meconium.