MICONIUM - HOW DANGEROUS IS SWALLOWING IT?

[Janus]

Please, please help. My best friend has just given birth and her baby boy is in intensive care for swallowing a large amount of miconium during the birth. They are talking about possible lung damage and brain damage but don't really know what damage there is at the moment. He is on a drip and ventilator and are waiting for him to get stronger, he is one day old.
Did anyone else experience this or know how serious this is? What are the likely outcomes? I can't ask my friend as we are all feeling terrible but want to give her some positive thoughts if possible.
Appreciate any replies.
Jane

I'm so sorry to hear about your friend's son. The condition is called, in the US, at least, meconium aspiration syndrome. He inhaled amniotic fluid which had meconium (the baby's first poop) in it. The inhalation is bad for two main reasons: the physical obstruction of the airways (the major reason) and the chemicals in the meconium which can harm the lungs, causing a certain type of pneumonia. The brain damage is a result of lack of oxygen in the blood and there was a chance his little lungs could have collapsed. Here's a general overview:
umm.drkoop.com/conditions/ency/article/001596.htm

There's still a decent chance he'll be fine.. the Dr Koop page says that permanent lung damage is rare. He's on a ventilator, so his lung shouldn't collapse. The big unknown is how long his oxygen supply was affected-- this determines the degree of brain damage (if he has any! if he inhaled the meconium on his way out, there's a good chance he doesn't have any).

Hopefully the little guy will start getting better very quickly.

Sorry for not having more encouraging info.
JJ

My daughter swallowed some meconium on the way out, was treated with suction & oxygen at birth and was a bit distressed for the first few hours, until she puked it up. After that she was totally fine - no ill effects at all. I was told it was a fairly common thing to happen. Hope your friend and baby are ok. You sound like a really good friend.

Janus, can you please tell me what the outcome was for your friend's son? My brother's wife has just had her second baby delivered by emergency c-section, after monitoring picked up signs of foetal distress. The baby has meconium aspiration syndrome and is in neonatal intensive care.

Mooma a friend of mine had a baby who ended up in hospital for about 10 days with this problem. Max is now 6 months and absolutely fine. It was very scarey as all situations like this are, and each baby is different. However I am sure that your brothers baby will be fine.

I have a lot of experience with SCBU (Special Care Baby Units) as my daughter spent 14 weeks in hospital having been born at 27 weeks and just 1lb 12oz. Now she is a total terror of 2.5 and except for being tiny you wouldn't know she was early (the HV thinks she talks and acts older!) In a few days this will all seem like a distant nightmare and you can get on and enjoy a lovely new baby.

Crunchie, thanks for your reassurance. Lucy had her first 'improvement' yesterday, in that the pure oxygen she is receiving through the breathing tube has been reduced to 30%, and she has been taken off adrenaline. However, she is still on a lot of other medication, and ventilated with both oxygen and nitrous oxide. She is still on the critical list.
As a complication of inhaling the meconium, she developed pulmonary hypertension, where the pressure in the pulmonary artery builds up when blood flow to the lungs is not as it should be. This is what they have to treat first, before they can hope to get her breathing independently. They say the hypertension is almost resolved, and it may take 14 days for the second part of the treatment. These are difficult days.

Dear Mooma
Very glad to say that he is absolutely fine, bonny and bright! He had swallowed a considerable amount and was very poorly and also in intensive care for about 2 or 3 days then to special care and for a few more days and then home on day 8. He too had what seemed numerous tubes in him but even by day 3 they took a few of them out. I think it was around day 3 that he started breathing on his own which was a big turning point. It was really scarey for the first few days especially when you see all the tubes out of him but he is honestly completely fine, the happiest baby I have probably ever seen (smiles ALL day, unreal!) and no long term effects.
I really do wish you all the luck as I know it is so distressing but I think if things are already improving this is a really positive sign.
If you need to know more specific timings etc then let me know as my friend will remember exactly what days things improved for her baby so I can ask.
Thinking of you.

Ah well, now I know your niece will be fine since her name is Lucy! That's my name too!

Good luck and keep us posted, Janus is right there are so many tubes and things to start with, but eventually things get better. I remember with real excitment the first day I saw my little Poppy with a tube or a monitor attatched to her, she was 13 weeks old! and had finally pulled out her feeding tube for the umpteenth time so they decided she probably didn't need it!

They are now trying to reduce the morphine dose. Up until now Lucy has been heavily sedated, and they want to reduce that to see if her lungs will begin to function, and also to conduct a brain scan to see if she was deprived of oxygen in the womb. Apparently they think something happened in utero to distress her, hence the passing of the meconium, which she then inhaled. Her cord blood was still well oxygenated at birth, but lack of adequate oxygen can be the reason for foetal distress, so there is a worry there. However, yesterday her doctor said that she was no longer "in serious trouble" but still "moderately ill". So thank you Crunchie and Janus for your messages of support and encouragement, and I pray that Lucy's outcome will be as good as that of your friends' babies.

Dear Mooma
Just to add that my friend had exactly the same thing - dosed with morphine for the first few days and then a few days later the added worry of having a brain scan and a check that the lungs were not permanently damaged. Everything showed up fine in all the final checks. Her baby boy really was very ill, at first they didn't think he'd make it through the first night, etc, it is so amazing how resillient they are.
Hope all is well.

Janus, thanks for posting. It sounds like an identical scenario to Lucy's, including the part about the first night. On a positive note, they have stopped the nitrous oxide and reduced the sedation ready for a brain scan today. Lucy's parents went home last night for a good sleep, after a session with a counsellor at the hospital. (I thought that was a brilliant facility). Today they are going to introduce Lucy to her 3 year old brother, who is as yet unaware of her existence. The fact that they feel ready to do that speaks volumes for how everybody feels about her prognosis.

My friend's first daughter had meconium aspiration due to her distress not being picked up during labour. She should have been delivered much earlier than she was. The baby was so ill that they gave her only a few hours to live, however with intensive care (including being taken to London by ambulance at 4 hours old)she pulled through remarkably quickly and is now a perfect 3 year old!

Lucy's brain scan was postponed from Wednesday until today. B and SIL are both very tense. Please keep Lucy in your thoughts today.

Lucy had her scan yesterday, but the consultant didn't turn up to interpret it, so B & SIL have to wait till Monday for the results. It's set them back emotionally, because they were all geared up for finding out yesterday.

Mooma, thinking of Lucy and her parents. I think it is disgusting that they have to wait over the weekend! Winnie x

Good God, I'm astounded, how can they do that to your poor B & SIL? I'm so surprised because they are usually so sensitive with new parents. I have everything crossed for you all and so sorry you all have to wait all weekend.
Thinking of you. x

Thank you so much for your support. I think the problem is, B & SIL now (rightly) regard the NICU staff as their baby's saviours, and so could not even have the satisfaction of throwing a massive strop at them, when they realised there would be a 48hr delay.

Mooma, your poor brother and sister in law. I hope the consultant turns up promptly this morning and that the news is good. What a worrying time for you all.

Well, poor B & SIL had to wait until yesterday to see the consultant, but the news is positive. He says as far as he can tell, Lucy's brain is functioning as it should be. She has also come off CPAP, which was the breathing assistance she was given after coming off the ventilator over the weekend. She is now breathing unaided, in an 'oxygen box' to keep the oxygen levels up. Yesterday she took 20ml of expressed milk via her feeding tube. When she first started having milk, it was 2ml. She is still on antibiotics and dextrose, and apparently had a rough time coming off the maasive doses of morphine she had at the start. The next major step will be an MRI scan at the end of next week, to verify and expand the brain scan they've already done.
B & SIL are feeling so much happier and more positive now. B told me yesterday was the first time he had seen Lucy without a hat, and what a dear little shape her head is!
Thanks so much for all your support.

Fantastic news Mooma. Thanks for keeping us informed.

I'm so pleased for you all, what good news. I have been thinking of you all and so glad it's good news.

Had to share with you that I went to see Lucy today. When I arrived with my brother, she woke up, looked very alert, and was following the sound of our voices with her eyes. She just has oxygen via a nasal tube now, and antibiotics to help deal with the gunge that is still in two areas of her lungs. My brother changed her, and then she was hungry so she had expressed milk from a bottle. It was so wonderful to see her feeding by sucking rather than via a tube. Yesterday she even managed to feed a bit from my SIL. She finds this tricky at the moment, but is improving all the time. I had a cuddle with her, and then gave her some more milk. It's hard to explain how wonderful it felt to hold her. Thought you'd be pleased top know of the great strides she's making.

That's fantastic, it must have been very moving for you all. Hope they're all home soon.
xx

Wonderful news Mooma. I too hope they are all home together soon. Best wishes Winnie