FATAL MECONIUM ASPIRATION IN SPITE OF APPROPRIATE PERINATAL AIRWAY MANAGEMENT - PULMONARY AND PLACENTAL EVIDENCE OF PRENATAL DISEASE

OBJECTIVE: Our purpose was to summarize eight cases of fatal meconium aspiration syndrome where pathologic review showed evidence of chronic prenatal disease and to compare these findings with those of a group of control infants and fetuses who died of other causes. STUDY DESIGN: A 15-year retrospective chart review identified the infants who died of meconium aspiration within 48 hours of life and who also had autops ies performed. Neonatal pulmonary and available placental pathologic f indings are described from these study infants and are compared with p ublished norms and with autopsy results from a group of control infant s and fetuses. RESULTS: Seven of the eight study infants underwent suc tioning of the trachea immediately after birth. In all eight cases the neonatal lungs demonstrated histologic evidence of significant hypoxi c changes of a chronic nature with onset before birth. The available p lacentas showed variable but significant abnormalities that support a case for subacute or chronic in utero compromise. CONCLUSIONS: As in o ther reports, there is evidence that meconium aspiration may be a pren atal rather than a postnatal disease. However, this is the first study that presents evidence on the basis of both pulmonary and placental p athologic findings and reinforces the importance of placental examinat ions in complicated pregnancies.