What is meconium? How long does it take for newborn babies to have it? What is meconium aspiration syndrome?

There are so many worries associated with the way a newborn baby “walks big.” Moms are concerned about the frequency of stool, its color, consistency. So how can you determine whether your baby’s digestion is okay? Perhaps he needs help?

Many mothers know that it is very important to monitor the baby’s stool, and during the examination the pediatrician is always interested in how the baby walks. This information is one of the most important points in diagnosing the baby’s health condition. Unfortunately, quite often mothers mistakenly interpret the completely natural and safe states of the baby. And because of these mistakes, they can begin unnecessary treatment and worry about the baby without any good reason. So let's figure out what a baby's stool should look like and when to worry and when not.

Description

Its composition is determined by intrauterine life and accumulates throughout the entire period of fetal development. It includes digested amniotic fluid containing fragments of prenatal hairs (without pigment and brain matter) and epithelial cells. Particles of bile and mucus are also found in meconium.

The baby begins to swallow amniotic fluid at 21 weeks of intrauterine development, when the digestive system is already sufficiently developed. Additionally, the swallowing reflex is trained. The fetus digests up to 500 ml of liquid per day, water from it is absorbed in the small intestine, the rest accumulates in the large intestine. Original feces differ from ordinary ones in their characteristics:

• The color ranges from dark green to black-brown, making meconium look like tar in all newborns;
• There is almost no smell;
• The viscosity is similar to toothpaste and is very sticky. It is not always easy to wash it off with plain water; it is recommended to treat clean skin with oil or diaper cream. After defecation, it will be easier to clean it of fecal residues;
• Sterility in the first few hours. Until recently, it was considered absolute, until Spanish researchers proved the presence of lactobacilli and several other types of microorganisms in meconium. After birth, their number gradually increases in the original feces and in the intestines;
• The acidity is 6 pH, it remains in breastfed children; when changing food, the value changes to 7-7.5.

Accumulated meconium in a newborn varies in amount from 60 to 100 g.

Characteristics of normal baby stool

So, how many days does it take for newborns to pass meconium? By seven days after the birth of the child, his stool should already return to normal, that is, acquire a yellow color and a pasty consistency, but in fact there may be other options that are not related to deviations.

• Color. A newborn's stool may include all shades of yellow. It may also have a greenish tint if there is a high level of bilirubin. Apart from this, sour smell, green color and impurities may arise due to the immature nature of the digestive system and liver. All this refers to variants of the norm and should pass over time.
• Consistency. A newborn's stool can be either loose or thick. It is considered normal in any case: if it is watery and leaves a yellow stain on the diaper and is thick, reminiscent of sour cream in consistency.

• Impurities. Normally, a variety of streaks, impurities and lumps can be observed in the stool of a newborn. All this will eliminate itself after the final establishment of the digestive process.
• The frequency of bowel movements is the main reason why inexperienced mothers worry and rack their brains. However, in fact, the frequency of stool is purely individual. Mainly in the first days of a baby’s life, his stool can be quite frequent, later it becomes increasingly rare, and at the end of the first month it is completely established. The frequency of stool is determined by intestinal peristalsis, the specifics of food digestion, the presence of the necessary microflora in the body and a large number of other properties, so normally a newborn can have any frequency of bowel movements, but usually their number reaches five to ten during the day. The main indicator is the child’s well-being. If he is active, cheerful and feeds well, sleeps soundly, and does not suffer from gas, then everything is fine with him, and such frequency depends on his individual characteristics.

However, various pathological conditions are also possible. Let's look at them.

Time of elimination from the body

The intestines are emptied in the first 24 hours after birth. How many times a day meconium is passed depends on the individual characteristics of the body. Typically, the number of bowel movements ranges from 1 to 3 times. On the 2nd and 3rd days, the stool is considered transitional, because it contains the remains of meconium, but the color changes to light brown, almost yellow.

Given the high viscosity of original feces, it is quite difficult for the baby to remove it from the body. Meconium passage occurs faster in those children who are breastfed at the very beginning. On the first day after birth, colostrum, similar to thick mucus, is released from the nipples. It contains many nutrients and has a mild laxative effect.

A week later, when the meconium has completely passed, the stool in newborns becomes baby-like, yellowish in color, mushy in consistency, with a sour milk smell. Deviations can occur due to digestive diseases, changes in the diet of a nursing mother.

Formula-fed babies are more likely to suffer from constipation or indigestion, and their stool may smell putrid. If you have any suspicions, you should consult a pediatrician and pay attention to the baby’s well-being.

If it doesn't leave for a long time

With a small amount of meconium and its discharge into the amniotic fluid, the child does not have bowel movements during the first day of life, sometimes longer. After the start of feeding, the intestines work normally. The situation is not critical if the baby feels good, sleeps peacefully, and does not suffer from bloating. Often, the doctor in the maternity hospital prescribes an enema to speed up the excretion of original feces.

Malnutrition of the infant can lead to delayed passage of meconium due to:

1. Irregularly shaped nipples - small or sunken, the baby is unable to grasp them correctly;
2. Insufficient production of colostrum in the mammary glands;
3. Physiological characteristics of the baby. The lower lip may fall under the upper lip, interfering with the normal sucking process.

The third reason for the delay is a pathological condition - meconium ileus, in which the original feces, due to its high viscosity, form a plug and block the intestinal lumen. The phenomenon can be observed in the following cases:

1. Malfunctions of the pancreas, insufficiency of enzymes to reduce the viscosity of original feces;
2. Cystic fibrosis is a hereditary disease that occurs in severe form. Accompanied by respiratory dysfunction. Occurs in 1 case out of 20 thousand.

Symptoms include absence of bowel movements for the first few days, bloating accompanied by pale and swollen skin, and possible vomiting with bile particles and green clots. Gradually, a decrease in activity is observed, signs of dehydration appear: dry skin, decreased blood pressure.

It is quite difficult to make a diagnosis; this usually occurs during surgery. Intestinal obstruction can be confirmed by barium x-rays. If the baby’s condition is not critical, before the operation they try to help him with a cleansing enema. Typically, a 3% pancreatin solution is used to liquefy stool. If meconium is not excreted for a long time, you need to inform your doctor so that timely assistance can be provided.

Meconium ileus

Meconium ileus is a form of congenital intestinal obstruction that occurs when the ileum is blocked by meconium. The disease occurs in one child out of 10-16 thousand newborns. In 70-80% of cases, meconium ileus is associated with cystic fibrosis, less often with atresia of the small intestine and prematurity. 14% of children with cystic fibrosis experienced meconium ileus in infancy.

Clinic

The first symptoms of the disease appear a day after birth due to the absence of bowel movements:

• excessive regurgitation, vomiting mixed with bile after 4-5 feedings;
• anxiety, crying;
• refusal to eat;
• bloating, increase in its size;
• the contours of the intestine are visible on the anterior abdominal wall;
• upon palpation, overcrowded loops of the small intestine are felt.

Subsequently, dehydration and electrolyte imbalance develop. The child becomes lethargic, and the functioning of the cardiovascular system is disrupted. Based on clinical data, the neonatologist makes a preliminary diagnosis of meconium ileus.

Diagnostics

To confirm the diagnosis and identify the cause of the pathology, the following studies are prescribed:

• Plain X-ray of the abdomen - the image shows distended intestinal loops. The presence of gas and dense meconium gives a characteristic x-ray picture: a symptom of ground glass and soap bubble.
• Irrigography – gastrografin (a contrast agent) is injected into the rectum using an enema and an x-ray is taken. With meconium ileus, the colon is empty, narrow (microcolon), filling defects are visible in the distal ileum - dense lumps of meconium. Using the study, the location of the intestinal blockage is determined.
• Computed tomography is a method for diagnosing the cause of intestinal obstruction; an X-ray examination is performed from different angles, then a three-dimensional image is obtained on a computer.
• Ultrasound - shows structural changes in the abdominal organs, pseudocysts, calcifications in the abdominal cavity.
• Sweat test - determination of chloride content in the secretion of sweat glands. This is the main laboratory method for diagnosing cystic fibrosis. The test is performed on all children with meconium ileus.

Be sure to read:

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Late diagnosis of the pathology leads to necrosis and perforation of the intestine, peritonitis. Sometimes complications develop in utero: meconium peritonitis, pseudocysts, fusion of the intestinal walls with the formation of stenosis.

Treatment

• Liquefaction and evacuation of feces - do enemas with gastrografin and a warm solution of sodium chloride. Hyperosmolar compounds attract water into the intestinal lumen, dilute stool, and promote its passage. In uncomplicated cases, 2-3 enemas are required to resolve intestinal obstruction.
• Gastric decompression - using a nasogastric tube, the contents of the stomach are removed.
• Infusion therapy - administration of fluids, electrolytes, solutions for parenteral nutrition.
• Enzymes . Enteral nutrition is started 2 days after intestinal patency is restored; in case of cystic fibrosis, enzyme preparations are necessarily added.
• Surgical methods of treatment . If conservative therapy is ineffective, congenital intestinal stenosis and complicated ileus, surgery is indicated. Its goal is to evacuate meconium and restore the patency of the digestive tract. The intestine is dissected, meconium is removed, and an anastomosis is performed. During surgery, they try to preserve the greatest length of the intestine.

Meconium aspiration

It is dangerous for the baby to get the original feces into the lungs, which is possible while in the womb or during labor. The name of this condition is meconium aspiration syndrome in newborns. The presence of original feces in the amniotic fluid can be detected even before birth, in the last stages of gestation. When performing an ultrasound, the amount of fluid and the degree of its transparency are assessed.

In case of oligohydramnios and turbidity, additional studies are prescribed. The presence of feces in the amniotic fluid can be confirmed using a special tube - an amnioscope. The device is inserted through the vagina and cervix and fluid is collected for analysis. The method allows you to avoid puncturing the amniotic sac.

Causes

Prolonged labor can cause asphyxia (suffocation), hypoxia (lack of oxygen). The condition leads to relaxation of the sphincter in the rectum and its spontaneous emptying. The accumulation of carbon dioxide in the blood can irritate the respiratory brain center, which leads to reflex inhalation of the fetus while in the womb. In this case, the child swallows amniotic fluid, some of which penetrates the lungs. The risk of meconium aspiration increases if:

1. First birth over 35 years of age;
2. Entwining the fetus with the umbilical cord;
3. Diabetes mellitus in a woman;
4. Rh conflict during pregnancy;
5. Toxicosis in a woman in late pregnancy;
6. Developmental delays;
7. Fetal presentation.

Most often, meconium is found in amniotic fluid during post-term pregnancy.

Reasons for delay

Doctors talk about meconium retention if the original feces are not passed in the first 24 hours of the baby’s life. This condition indicates the presence of a pathology of the digestive tract and is very dangerous for the baby.

The main causes of meconium retention:

• congenital anomalies of the intestinal tract , which lead to obstruction. Such defects include atresia of a section of the large or small intestine, anus, the presence of a membrane in the duodenum, and an annular pancreas. Such pathologies usually develop against the background of chromosomal abnormalities and defects of other internal organs;
• Hirschsprung's disease . This is a congenital pathology. It is characterized by the absence or underdevelopment of the intestinal nerve plexuses that regulate its motility. This condition leads to obstruction of the affected area. Parts of the intestine become overfilled with feces and expand;
• immaturity of the function of the digestive tract organs . This condition is typical for premature babies. A decrease in secretion and intestinal motility causes fecal stagnation;
• cystic fibrosis . This is a multiorgan severe disease that is inherited in an autosomal recessive manner. With cystic fibrosis, pancreatic secretions become viscous. The organ does not produce enough enzymes. Absorption of fluid from the intestinal lumen increases. With such a deviation, the consistency and discharge of original feces change;
• meconium plug syndrome . It is observed when there is an accumulation of original feces in the large intestine. Occurs due to impaired motor function of the organ. Meconium plug syndrome is typical for children born to mothers diagnosed with hypermagnesemia or diabetes mellitus.

Signs

Aspiration syndrome occurs more often if the amniotic fluid is cloudy and greenish in color. An hour after meconium particles enter the lungs, small branches of the bronchial tree become blocked, preventing them from taking their first breath on their own.

With asphyxia due to original feces, the following signs are observed:

• Remains of feces on the skin of the newborn, its coloring in a dark, bluish color, as well as the nails and umbilical cord;
• The presence of meconium particles in the oral cavity and trachea;
• Ventilation of the lungs confirms the presence of water with meconium in them;
• Breathing is difficult for the baby, attempts to inhale are accompanied by retraction of the intercostal spaces, tension of the wings of the nose;
• Breathing is intermittent, shallow;
• Complete lack of breathing;
• The chest is enlarged in size.

Sometimes aspiration becomes symptomatic a few minutes after birth.

How long does it take?

Many young parents are interested in how many days a newborn has meconium. In healthy children, meconium is passed on the first day, from the third to the twentieth hour after birth.

On the second or third day, bowel movements are called transitional: they contain the remains of meconium and digested food. First, streaks and impurities are visible in the feces.

But gradually the feces become mushy and homogeneous. A baby's normal stool is yellow and runny.

Necessary measures

When amniotic fluid is contaminated, there is a high probability of intrauterine fetal hypoxia. The doctor assesses his condition, based on which he determines further management of the birth. Clear signs of oxygen starvation are the reason for a cesarean section and fetal extraction.

To detect amniotic fluid in the lungs after birth, doctors use the following diagnostic methods:

• Assess the skin;
• Examine the condition of the chest;
• Listen to the lungs;
• The lungs are pounding;
• An x-ray is taken.

Depending on the results of the research, the following measures may be applied:

1. Immediate resuscitation, suctioning water from the lungs;
2. Cleansing the respiratory tract;
3. Providing warm conditions for the baby;
4. Suctioning meconium from the trachea using a special tube;
5. Ventilation of the lungs using a special device;
6. Injection of medicinal fluid into the lungs;
7. Antibiotic therapy.

Further actions depend on the severity of the clinical picture. During treatment, the baby may not be fed on the first day, and maintenance solutions are administered intravenously. After therapy, the condition is monitored; if the dynamics are positive, an x-ray of the lungs shows improvement within 7-14 days.

Possible consequences

If meconium passes into the amniotic fluid and enters the lungs, even if first aid is provided in a timely manner, many children suffer from complications such as:

• Respiratory failure;
• Increased pressure in the lungs;
• Tracheitis;
• Swelling of tissues in the lungs;
• Air leaks (detected outside the airways due to tissue rupture);
• Sepsis, infectious tissue damage;
• Pneumonia;
• Disturbances in the development of the nerve system;
• Threats of death (about 10% of cases).

The consequences are less threatening to the baby if meconium is detected in the amniotic fluid in a timely manner and the correct first aid actions are taken. This situation is difficult to prevent; it largely depends on the course of pregnancy. To avoid complications, you need to monitor your well-being and state of health, follow the instructions of the supervising doctor and adhere to the schedule of his visits.