Meconium Aspiration Syndrome

A term newborn (38 weeks gestation) born to a mother with meconium-stained amniotic fluid presents with tachypnea (RR 68/min), grunting, and intercostal retractions within 2 hours of birth. Apgar scores were 8 and 9 at 1 and 5 minutes. Chest X-ray shows patchy infiltrates with hyperinflation and areas of atelectasis. SpO₂ is 88% on room air. What is the most appropriate immediate next step in management?

A 6-hour-old term newborn with meconium aspiration syndrome is now on mechanical ventilation with FiO₂ 0.6 and mean airway pressure 12 cm H₂O. Arterial blood gas shows pH 7.28, PaCO₂ 52 mmHg, PaO₂ 65 mmHg, HCO₃⁻ 24 mEq/L. Chest X-ray shows bilateral patchy infiltrates without pneumothorax. The infant is on routine antibiotics and supportive care. What is the most appropriate next step in management?

A term neonate born to a mother with prolonged rupture of membranes presents with respiratory distress 2 hours after birth. Chest X-ray shows patchy infiltrates with hyperinflation. Which clinical feature best distinguishes meconium aspiration syndrome (MAS) from transient tachypnea of the newborn (TTN)?

A term newborn born to a mother with meconium-stained amniotic fluid develops respiratory distress within 2 hours of birth. Chest X-ray shows patchy infiltrates with hyperinflation. The infant is on supplemental oxygen and mechanical ventilation. What is the drug of choice for managing the underlying pulmonary inflammation and air trapping in meconium aspiration syndrome?

A 2-hour-old term newborn with meconium-stained amniotic fluid develops severe hypoxemia (SpO₂ 75% on 100% oxygen) and clinical signs of pulmonary hypertension despite surfactant administration and conventional mechanical ventilation. Echocardiography confirms right-to-left shunting across the foramen ovale. Which drug is indicated to reduce pulmonary vascular resistance in this scenario?