A newborn delivered at 42 weeks gestation presents with meconium-stained amniotic fluid and respiratory distress. Which assessment finding would be MOST indicative of meconium aspiration syndrome?

Key Indicators: In a post-term newborn with meconium-stained fluid, the hallmark of MAS is evidence of airway obstruction and air trapping. Look for a barrel-shaped chest, coarse crackles, and decreased breath sounds. Other signs include tachypnea, grunting, nasal flaring, and cyanosis.

• Airway Management: If the newborn is not vigorous (poor muscle tone, inadequate respirations), intubate and suction meconium directly from the trachea before positive pressure ventilation.
• Respiratory Support: Provide supplemental oxygen to maintain saturation between 90-95%. Use CPAP for mild distress; intubate and initiate mechanical ventilation for severe distress or hypercapnia.
• Thermoregulation: Place under a radiant warmer to prevent cold stress, which increases oxygen consumption.

Continuously monitor oxygen saturation, respiratory rate, and work of breathing. Obtain a chest X-ray to confirm patchy infiltrates and hyperinflation. Monitor blood gases for hypoxemia and respiratory acidosis. Watch for complications like pneumothorax or persistent pulmonary hypertension.

Minimize handling to reduce oxygen demand. Position the infant to optimize ventilation-perfusion matching. Provide supportive care including IV fluids and antibiotics if sepsis is suspected. Educate parents on the disease process and expected monitoring in the NICU.