BACKGROUND: Delivery room management of infants born via meconium-stained amniotic fluid (MSAF) is quite controversial. No study has tried to quantify the amount of meconium that can be aspirated from the trachea of a non-vigorous neonate born through MSAF. AIMS: To study the yield of meconium in non-vigorous neonates born through MSAF undergoing endotracheal (ET) suctioning. METHODS: This was a prospective observational study conducted from 1 March 2015 to 31 October 2015. A total of 760 neonates born through MSAF were enrolled. All non-vigorous neonates underwent ET suctioning. Meconium aspirated was quantified as nil (no meconium aspirated), insignificant (when only streaks of meconium were present in the ET tube), minimal (when the whole length of ET tube was filled with meconium) and significant (when the whole ET tube was filled with meconium and it poured into the suction tubing or when repeat suctioning was required). RESULTS: The amount of meconium aspirated from the trachea was nil to insignificant in 46% of the neonates who underwent tracheal suctioning. Only 14.4% of the neonates had significant meconium aspirated from the trachea. Almost 46% of the non-vigorous infants underwent tracheal suctioning without any important amount of meconium being aspirated from the trachea. CONCLUSION: The study further supports the recommendation put forth by the International Liaison Committee on Resuscitation (ILCOR) 2015 that selective intubation and tracheal suctioning of non-vigorous MSAF neonates might be of limited benefit. ABBREVIATIONS: ET: endotracheal; ILCOR: International Liaison Committee on Resuscitation; HIE: hypoxic ischaemic encephalopathy; LMIC: low- and middle-income countries; MAS: meconium aspiration syndrome; MSAF: meconium-stained amniotic fluid; NRP: neonatal resuscitation programme; PPHN: persistent pulmonary hypertension of the newborn; RCT: randomised controlled trial.
BACKGROUND: Delivery room management of infants born via meconium-stained amniotic fluid (MSAF) is quite controversial. No study has tried to quantify the amount of meconium that can be aspirated from the trachea of a non-vigorous neonate born through MSAF. AIMS: To study the yield of meconium in non-vigorous neonates born through MSAF undergoing endotracheal (ET) suctioning. METHODS: This was a prospective observational study conducted from 1 March 2015 to 31 October 2015. A total of 760 neonates born through MSAF were enrolled. All non-vigorous neonates underwent ET suctioning. Meconium aspirated was quantified as nil (no meconium aspirated), insignificant (when only streaks of meconium were present in the ET tube), minimal (when the whole length of ET tube was filled with meconium) and significant (when the whole ET tube was filled with meconium and it poured into the suction tubing or when repeat suctioning was required). RESULTS: The amount of meconium aspirated from the trachea was nil to insignificant in 46% of the neonates who underwent tracheal suctioning. Only 14.4% of the neonates had significant meconium aspirated from the trachea. Almost 46% of the non-vigorous infants underwent tracheal suctioning without any important amount of meconium being aspirated from the trachea. CONCLUSION: The study further supports the recommendation put forth by the International Liaison Committee on Resuscitation (ILCOR) 2015 that selective intubation and tracheal suctioning of non-vigorous MSAF neonates might be of limited benefit. ABBREVIATIONS: ET: endotracheal; ILCOR: International Liaison Committee on Resuscitation; HIE: hypoxic ischaemic encephalopathy; LMIC: low- and middle-income countries; MAS: meconium aspiration syndrome; MSAF: meconium-stained amniotic fluid; NRP: neonatal resuscitation programme; PPHN: persistent pulmonary hypertension of the newborn; RCT: randomised controlled trial.