Meconium Aspiration Syndrome

A 2-hour-old male neonate born to a 28-year-old primigravida at 38 weeks gestation presents with respiratory distress. The delivery was complicated by thick meconium-stained amniotic fluid (MSAF). The infant required vigorous suctioning of the oropharynx and nasopharynx at delivery. Apgar scores were 7 at 1 minute and 9 at 5 minutes. Currently, the baby has a respiratory rate of 68/min, mild intercostal retractions, and oxygen saturation of 88% on room air. Chest X-ray shows hyperinflation with patchy infiltrates and areas of atelectasis. Blood gas analysis reveals pH 7.28, PaCO₂ 52 mmHg, PaO₂ 65 mmHg on room air. Which of the following is the most appropriate initial management?

A 6-hour-old female neonate born at 39 weeks gestation to a 32-year-old mother presents with progressive respiratory distress. Delivery was vaginal with thick meconium-stained amniotic fluid. The infant required bag-and-mask ventilation at birth (Apgar 5 at 1 min, 8 at 5 min). She was started on CPAP with FiO₂ 0.4 but has worsened over the past 2 hours. Current vital signs: RR 82/min, severe intercostal and subcostal retractions, SpO₂ 82% on CPAP with FiO₂ 0.6, HR 165/min. Chest X-ray shows hyperinflation, patchy consolidation, and a **right-sided pneumothorax**. Arterial blood gas: pH 7.18, PaCO₂ 68 mmHg, PaO₂ 58 mmHg. What is the most appropriate next step in management?

Which radiologic finding is MOST characteristic of meconium aspiration syndrome on chest X-ray?

Which of the following is the PRIMARY mechanism of airway obstruction in meconium aspiration syndrome?

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?