Meconium-stained amniotic fluid: delivery room management

Recent studies do not support the use of routine endotracheal suctioning at birth in vigorous meconium-stained babies to reduce the incidence of meconium aspiration syndrome or other adverse outcomes.

In accord with the latest NRP guidelines:

All babies with meconium-stained amniotic fluid should have their oropharynx and nares suctioned with a catheter or bulb syringe by the obstetrician/midwife upon delivery of the head before delivering the shoulders.

Meconium-stained infants who are vigorous (strong respiratory effort, good tone, and HR > 100bpm) should have their mouth then nose suctioned with a large-bore (14F) catheter to clear secretions. These infants require only routine assessment and delivery room care. (However, if an initially vigorous meconium-stained infant subsequently develops respiratory distress, he/she may require intubation and endotracheal suctioning.)

Meconium-stained infants with evidence of birth depression (weak or no repiratory effort, gasping, poor tone, or HR <100bpm) should be intubated and suctioned with a meconium-aspirator before stimulation or positive-pressure ventilation. Endotracheal suctioning should be repeated until the airway is clear or the infant’s condition demands immediate resuscitative efforts.

These recommendations for delivery room management of the meconium-stained newborn rely only on assessment of the condition of the infant. Consistency of the meconium (thick vs.thin) is not a deciding factor.

References:

AAP and AHA. Textbook of Neonatal Resuscitation, 4^th edition. 2000.

Halliday HL. Endotracheal intubation at birth for preventing morbidity and mortality in vigorous, meconium-stained infatns born at term. Cochrane Collaborative Reviews.  http://www.nichd.nih.gov/cochrane/Halliday/Halliday.htm

Wiswell TE, Gannon CM, Jacob J, et al. Delivery Room Management of the Apparently Vigorous Meconium-stained Neonate: Results of the Multicenter, International Collaborative Trial. Pediatrics 2000;105:1-7.