What is meconium aspiration syndrome (MAS) and its typical management?

• A. Airway obstruction and chemical pneumonitis from meconium; management includes supportive care, airway clearance and, in severe cases, endotracheal suctioning in non-vigorous infants
• B. Viral pneumonia with diffuse alveolar damage; management includes antibiotics
• C. Pulmonary hypertension from delayed breathing; management includes inhaled NO
• D. Cystic fibrosis-related mucus plugging; management includes chest physiotherapy

Answer: (A)

Meconium aspiration syndrome occurs when a newborn inhales meconium-stained amniotic fluid, leading to airway obstruction and chemical irritation (pneumonitis) that disrupts gas exchange. The typical management focuses on supporting oxygenation and clearing the airways. In infants who are not vigorous at birth, endotracheal suctioning is recommended to remove meconium directly from the airways. Beyond suctioning, efforts center on airway clearance and respiratory support—oxygen, and ventilation if needed (ranging from CPAP to mechanical ventilation). Antibiotics are not routinely used unless there's concern for sepsis, and therapies like inhaled nitric oxide are reserved for cases with persistent pulmonary hypertension rather than MAS itself. This combination—airway obstruction with chemical injury, plus supportive care and airway clearance, including endotracheal suctioning in non‑vigorous infants—best matches MAS management.