Central cyanosis in newborns and the course and management of MAS
THE CONTEXT
The target text covers the pathological significance of central cyanosis and describes the neonatal respiratory condition labeled MAS.
Central cyanosis
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Central cyanosis in a newborn always indicates an underlying pathological condition.
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Cardiac and respiratory conditions cause most cases. A stepwise clinical and radiological approach facilitates early diagnosis and management.
MAS: presentation and complications
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Meconium induces chemical pneumonitis.
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MAS usually occurs in term or post-term neonates, who are often small for gestational age.
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Respiratory distress develops within a few hours and worsens over the next 24–48 hours. Untreated distress can progress to respiratory failure.
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Complications include pneumothorax and other air leak syndromes, including pneumopericardium and pneumomediastinum.
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Hypoxia can lead to persistent pulmonary hypertension.
Management and outcomes of MAS
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Unnecessary disturbance can worsen persistent pulmonary hypertension.
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Supportive care includes thermal protection, intravenous fluids, and monitoring.
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Judicious oxygen use, continuous positive airway pressure (CPAP), and mechanical ventilation help maintain oxygenation and ventilation.
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Some neonates require inhaled nitric oxide to reduce pulmonary artery hypertension.
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With improved neonatal intensive care and ventilatory support, mortality in severe MAS has fallen to 18–20%. Survivors have a high risk of childhood asthma.