Patient's question:
At birth, inhaling amniotic fluid and meconium caused mild brain damage, and the baby was admitted to the hospital for emergency rescue. How should the treatment be carried out?Doctor's answer:
(1) Oxygen therapy should be selected based on the degree of hypoxia, using methods such as nasal cannula, mask, or hood to maintain PoO2 at 60–80 mmHg (7.9–10.6 kPa) or TcSO2 at 90%–95%.(2) Correction of acidosis: Under conditions of maintaining airway patency and providing oxygen therapy, if the base excess (BE) is greater than -6, alkaline drugs should be administered. The dosage can be calculated using the formula: 5% sodium bicarbonate mL = -BE × body weight × 0.5. If the BE is less than -6, correction can be achieved by improving circulation.
(3) Maintaining normal circulation: In cases of hypothermia, pallor, hypotension, or other shock manifestations, plasma, whole blood, 5% albumin, or normal saline should be used for volume expansion, while dopamine and/or dobutamine should be administered intravenously.
(4) Mechanical ventilation: Mechanical ventilation should be performed if indicated, but inspiratory pressure and expiratory membrane pressure should not be excessively high to avoid pulmonary air leaks. Continuous positive airway pressure (CPAP) is also not recommended.
(5) Limiting fluid intake: Severe cases often accompany cerebral edema, and a few may also have pulmonary edema or heart failure, so fluid intake should be appropriately restricted.
(6) Antibiotics: For secondary bacterial infections, antibiotics should be administered based on bacterial culture and susceptibility test results from blood and tracheal aspirates.
(7) Surfactant therapy: The clinical efficacy of surfactant treatment for meconium aspiration syndrome (MAS) remains to be confirmed.