When should I consider referring a newborn with Meconium Aspiration Syndrome to a specialist unit?

Consider referring a newborn with Meconium Aspiration Syndrome (MAS) to a specialist unit if any of the following clinical signs are present after birth:

• Respiratory rate above 60 breaths per minute
• Presence of grunting
• Heart rate below 100 or above 160 beats per minute
• Capillary refill time above 3 seconds
• Body temperature of 38°C or above, or 37.5°C on two occasions 15 to 30 minutes apart
• Oxygen saturation below 95%
• Presence of central cyanosis, confirmed by pulse oximetry if available

If the baby has significant meconium but is otherwise healthy, close observation in a unit with immediate access to a neonatologist is recommended, with monitoring at 1 and 2 hours old and then every 2 hours until 12 hours old.

Additionally, if the baby does not have normal respiration, heart rate, and tone after any degree of meconium exposure, follow nationally accredited neonatal resuscitation guidelines and consider referral.

Transfer both mother and baby if they are at home or in a freestanding midwifery unit and these concerning signs are present, following established emergency referral pathways.