MECONIUM ASPIRATION SYNDROME AND HYDROCEPHALUS: A CASE REPORT

Abstract

Meconium aspiration syndrome (MAS) is an uncommon but severe neonatal condition in which the presence of meconium within the airways leads to mechanical obstruction, chemical inflammation and surfactant dysfunction. Initial stabilization in the delivery room plays a fundamental role in determining outcomes. Although MAS is well described in the literature, intracranial hemorrhage and the subsequent development of hydrocephalus represent exceptionally rare complications, most often associated with severe hypoxia, hemodynamic instability, and the fragility of the neonatal cerebral vasculature.

We present the case of a term male newborn delivered through meconium-stained amniotic fluid who developed respiratory distress. Upon admission to the neonatal intensive care unit, blood gas analysis revealed respiratory acidosis, while chest radiography demonstrated a “snowstorm” appearance with confluent nodular opacities and areas of atelectasis and hyperinflation. The infant required endotracheal intubation and conventional mechanical ventilation, followed by surfactant lavages, antibiotic and corticosteroid therapy, and initiation of a phosphodiesterase-5 inhibitor due to emerging pulmonary hypertension. After extubation, non-invasive ventilation with B-CPAP was applied, followed by oxygen supplementation. On day 40 of hospitalization, neurological abnormalities and the “sunset eye” sign were noted. Subsequent ultrasound and neuroimaging revealed marked ventricular dilation and intracranial hemorrhage. Following neurosurgical consultation, a ventriculoperitoneal shunt was placed, after which the infant was transferred for continued management and ultimately discharged home.

Meconium aspiration syndrome remains an important cause of neonatal respiratory distress and warrants timely recognition of associated comorbidities such as hydrocephalus. Early detection and a multidisciplinary approach are essential for optimizing neurological and respiratory outcomes in newborns.