It is one of the first signs that show that baby is well and that he is a real little person: his first somewhat special stools, meconium, dark green in color which tends towards black, very viscous and l appearance close to tar, reassures parents and caregivers in maternity after birth.
When is meconium formed?
As you know, most organs in the fetus don’t wait for birth to start functioning. This is how, in utero, from the 4th month of pregnancy, the liver and the other elements of the digestive system start up, and a green substance, meconium, consisting in particular of the bile rejected by the vesicle and mucus , is already starting to build up in the intestines.
Meconium is such a specific material that it is also used in some research with umbilical cord blood to estimate fetal exposure to contaminants such as lead and mercury. The MIREC study (Maternal-Infant Research on Environmental Chemicals) conducted in Canada between 2008 and 2011 (1) shows that lead and mercury cross the placenta fairly easily to reach the fetus. Lead and mercury levels are even found to be higher in cord blood than in mother’s blood when exposed during pregnancy, and high levels of metals such as lead and mercury can be harmful to health. You can discover the many pages of this study on this link.
When is meconium removed?
When all is well, the emission of meconium takes place in the first 12 to 24 hours after childbirth. If this first fecal matter is delayed, then we speak of a delay in the elimination of meconium in the newborn. There are several reasons for this and there is not necessarily cause for concern: your baby’s digestive system may just be a little lazy, and in most cases this first poo will be expelled at the end 48 hours.
Midwives and pediatricians will monitor your infant anyway to make sure it is not constipation or a meconial plug, also called the intestinal ileus, in the colon, which should then be peeled off. using an enema.
In very rare cases, this delay in expelling meconium during the first hours of life may constitute one sign among others of a more serious pathology such as cystic fibrosis or Hirschsprung disease, responsible for a malformation of the intestines and colon.
If you have chosen to breastfeed your baby, be aware that colostrum, the first milk produced during the first few days after delivery, acts as a laxative, which makes it possible to evacuate the meconium more quickly.
How to clean baby’s bottom properly?
Anyone who has already changed the first layer of a newborn baby knows how difficult it is to completely get rid of the sticky, sticky substance that is meconium on baby’s bottom. A step all the more stressful when it is a first child and that one feels a little awkward in all manipulations. If the meconium has not had time to dry, you can remove it with a cloth or cotton cloth with lukewarm water. If it is more tenacious, then use oleo-limestone liniment which will cleanse your child’s buttocks without risk of irritation, and will deposit a greasy film which will prevent the meconium from sticking to the skin.
Rest assured, after the third day of life, the stools will become increasingly clear, to take a golden yellow color, and will be much easier to clean.
What is meconial amniotic fluid?
It may happen that the expulsion of meconium takes place in utero, often when the pregnancy comes to an end or it has passed the term, during labor or outside. It is still difficult to know exactly why this early emission occurs but studies lean towards a fetal distress which would encourage the fetus to relax its muscles, including the anal sphincter, to protect certain organs.
The amniotic fluid will then take on a more or less greenish color depending on the quantity of meconium emitted, varying between a moderate meconial amniotic liquid and a mecanic amniotic liquid “pea puree”.
Rest assured, the frequency of meconial amniotic fluid is on average 15%, with meconium levels ranging from 7 to 22% according to different studies, as we indicate doctor Aly Abbara on his site.
This meconial amniotic fluid should be monitored and taken into account during childbirth, especially in the presence of infection, respiratory problems or even heart problems (2).
What is Meconial Inhalation Syndrome?
Because in rare cases, the fetus can inhale this meconium fluid in its lungs during its first breaths or even, according to some studies, during respiratory movements in utero due to hypoxia, that is to say to a lack of oxygenation. This meconial inhalation syndrome can then create, on the clinical level, respiratory distress or more or less serious respiratory disorders, such as pulmonary emphysema or pulmonary arterial hypertension, and with more or less serious consequences on the lungs and more generally on the future health of children.
Some studies (3) show, however, that meconial amniotic fluid is not always a sign of fetal hypoxia, and that fetal hypoxia can occur with clear amniotic fluid.
Aspiration of the respiratory tract by suction using a tube can then be practiced by the midwife and a possible assumption of responsibility in intensive care can be recommended to bring oxygen to the baby with breathing difficulty, and watch for any risk of infection and the presence of meconium in the lungs.
French and foreign doctors’ responses
Medicine is still looking for the most effective responses to this meconial inhalation syndrome at birth. The many pages of the 2005 Updates in Gynecology and Obstetrics of the 2005 National College of French Gynecologists and Obstetricians tell us that a study did not allow us to conclude the advantage of having recourse to amnio-infusion during the work, to replace the meconial amniotic fluid.
Another clinical trial shows that tracheal aspiration before delivery of the shoulders, to avoid meconium inhalation syndrome, cannot necessarily be recommended.
These results are confirmed in the few pages of the 2009 Technical Update of the Society of Obstetricians and Gynecologists of Canada, analyzed by the Fetal-Maternal Medicine Committee. She concluded that failing to aspirate the airways is as safe as routinely aspirating the airways to the perineum for children born in the presence of amniotic fluid tinged with meconium.
(1) Maternal and fetal exposure to cadmium, lead, manganese and mercury: the MIREC Study, in French: Maternal and fetal exposure to lead, mercury, cadmium and manganese: the MIREC Arbuckle TE study, Liang CL, Morisset AS, Fisher M, Weiler H, Mihai Cirtiu C, Legrand M, Davis K, Ettinger AS, Fraser WD, the MIREC Study Group. Chemosphere. 2016 Nov; 163: 270-82. doi: 10.1016 / j.chemosphere.2016.08.023
(2) Study by Blot P et al. Fetal tachycardia and meconium staining a sign of fetal infection. Int. J. Gynaecol. Obstet. 1983, 21: pages 189-194
(3) Study by Low JA, Pickersgrill. H, Killen H et al. The prediction and prevention of intra-partum fetal asphyxia in term pregnancies. Am. J. Obstet. Gynecol. 2001, 184: pages 724-730
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