Meconium aspiration syndrome — clinical reasoning case

Clinical Presentation

A 3.8 kg male infant is delivered at 41+4 weeks' gestation by emergency caesarean section for fetal bradycardia and thick, pea-soup meconium-stained amniotic fluid. Apgar scores are 2, 4, and 6 at 1, 5 and 10 minutes. Pregnancy was complicated by gestational hypertension and reduced fetal movements in the preceding 24 hours. ^[7]

At delivery the infant is floppy, apnoeic and centrally cyanosed with heart rate 70/min. He is resuscitated with positive-pressure ventilation via mask then intubated; heart rate rises to 140. Cord blood gases show arterial pH 7.02, base excess minus 12 ^[7].