CASE PRESENTATION ON MECONIUM STAINED

AMNIOTIC FLUID WITH MECONIUM ASPIRATION

SYNDROME

Presented by

T.Uma Devi

4th Pharm-D

(611171602024)

PATIENT PROFILE FORM

• Patient’s mother name:- Nagamani• Age:-1day • Weight:-3kgs• Unit:-NICUI • Gender:-Male• IP no:-65360

REASONS FOR ADMISSION

• Yellowish colour of skin and nails, respiratory disstress, tachypnea. postive bilatéral air entry.

Past medical history:-• Not significant.

Past medication history:-

Not significant.

Family history:-

As the patient new born ,so their is no history.

DIAGNOSIS

MECONIUM STAINED

AMNIOTIC FLUID WITH

MECONIUM ASPIRATION

SYNDROME

PHARMACEUTICAL CARE PLAN

Subjective Evidence:-

Yellowish colour of skin and nails, respiratory disstress,

tachypnea, positive bilatéral air entry.

Objective Evidence:-

Chest X-ray, Stethoscope, Blood gas test.

Assessment:-

Based on subjective and objective evidences the diagnosis was made as  Meconium stained amniotic fluid with meconium aspiration syndrome.

GOALS TO BE ACHIEVED

• To reduce respiratory dystress.• To increase oxygen supply to new born.• To reduce the intestinal infection caused by

meconium.• To reduce the meconium levels in the boby.

TREATMENT OPTIONS

1. Antibiotics:- Ampicilline , gentamicine

2. Warmth care by• Mother • Radiant warmer• Ventilator

3. Oxygen therapy by• Masks• hoods

4. Amnio infusion

5. Extra corporeal membrane

MECONIUM STAINED AMNIOTIC FLUID (MSAF)

• Greenish or yellowish appearence of the amniotic fluid. Infants skin, umblical cord , nail beds may be stained green if the meconium was passed a considerable amount of time before birth. Inhaled in the fluid by gasping in utero or after birth.

MECONIUM ASPIRATION SYNDROME (MAS)

• Meconium is dark –green faecal material that was produced in the intestine of a foetus before birth. After delivery new born expels meconium stools for the first few days of life. Stress baby experiences before or during birth may cause expulsion of meconium into the amniotic fluid.

• If méconium is present in the amniotic fluid, this is known as meconium aspiration syndrome.

Patchy asymmetric airspace disease that is typical of MAS

Close up of left lung demonstrating the streaky lucencies of the air in the interstitium (red arrows) complicated by a pneumothorax

(yellow arrow).

DRUG CHART

Sno Drugs list Dose Route Frequency D1 D2 D3 D4 D5

1 Warmth care - - - X X X X

2 Oxygen inhalation with hood

5liters Nasal - X X X X

3 IVF-10%Dextrose

180ml IV 1-0-0 X X X

4 Inj.Ampiclox 150mg IV 1-0-1

5 Inj.Amikacin 45mg IV 1-0-0

6 Inj.Vitamin-K 8 μgm IM 1-0-0 (first 24 hours)

X X X X

DAY-1

• Heart rate:-120/min • RR:-68/MIN• CRT:- <3sec• SPO2:-97%• Weight:-3kgs• CVS:-S1 S2+• Conscious• A febrile• R/S:-B/L + , no added sounds

DAY-2

• HR:- 135/MIN• RR:- 44/MIN• CRT:- <3sec• SPO2:- 98%• P/A:- Soft• Weight:- 3kgs

DAY-3

• HR:-170/MIN• RR:-46/MIN• CRT:-<2sec• SPO2:-98%• P/A:-Soft• Weight:-3.25kgs• Rooting and suckling is good.

DAY-4

• HR:-140/MIN• RR:-40/MIN• CRT:-<2sec• SPO2:-97%• P/A:-Soft• Weight:-3.4kgs

DAY-5

• HR:-140/MIN• RR:-46/MIN• CRT:-<2sec• SPO2:-97%• P/A:-Soft• Weight:-3.5kgs

INVESTIGATIONS

• Blood gas analysis:-Low blood PH ,increased CO2 and decreased O2.

• Chest X-ray:-Patchy infiltrates, coarse streaking of both lungs and flattening of the diaphragm.

• CRT:- <2sec • Stethoscope:- Abnormal lung sounds are heard. • Cry:- Good General condition:-Alert• Single , terminal• Normal vaginal delivery• Accurate gestation age

GOALS ACHIEVED

• Respiratory disstress was decreased by day-3.• Complete meconium was removed from the

body by day-2.• Intestinal infections are reduced.• Oxygen is sufficient supplying to the baby.• Rooting and sucking is good by day-3.

MONITORING PARAMETERS

• Blood gas test is to confirm lung function by calculating O2 intake.

• Chest X-ray is for to see patchy or streaked areas on the lungs.

• Listen to the grunt sounds regularly from time to time

PATIENT COUNSELLING

• About disease:-

Mother should take care of the new born.Mother warm care is important. Oxygen supply should be increased for new borns.

About drugs:-• IVF-Dextrose:-

As the patient is not on feeding. So nutrients required for the body is supplied by this dextrose .

• Ampiclox:-Ampicillin+Cloxacillin As meconium is injected by the baby.It is

very infectious as it contains fecal material.So to decrease those infections this antibiotic is

used twice a day.