Meconium-stained Liquor and Meconium Aspiration


Reviewed by Clinical Practice Committee
May 2016
Clinical Guidelines Back Newborn Services Home Page
Delivery Room Management Further Management Criteria for Admission to NICU
Management of the Symptomatic  Infant Complications of Meconium Aspiration References

Delivery Room Management

Intrapartum pharyngeal suction is not indicated 1

Routine endotracheal suction is not indicated 1

  1. If the baby is apparently vigorous at birth (heart rate >100, spontaneous respiration, reasonable tone), intubation and tracheal suction is not indicated, unless the baby subsequently has poor respiratory effort or early respiratory distress. 3
  2. Intubation of vigorous babies does not improve respiratory outcomes and can result in trauma to the infant as well as inducing apnoea.
  1. For babies who are not vigorous (not breathing or crying, low muscle tone) current evidence does not support or refute the value of routine endotracheal suctioning in preventing MAS. 1,4
  2. Emphasis should be made on initiating ventilation rapidly in non-breathing or ineffectively breathing infants.
  3. If tracheal suction is performed:
  1. If pharyngeal suction is required to remove meconium obstructing the airway, it must be under direct vision e.g. using a laryngoscope.

Further Management

Criteria for Admission to NICU

Management of the Symptomatic Infant

Complications of Meconium Aspiration


1 Wyllie J, Perlman JM, Kattwinkel J, et al. Part 7: Neonatal resuscitation: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation. 2015;95:e169-201
2 Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Vain NE, Szyld EG, et al. Lancet 2004: 364: 597-602
3 Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Wiswell TE, Gannon CM, Jacob J, et al.  Pediatrics 2000; 105:1-7.
4 ANZCOR Guideline 13.4 Airway Management and Mask Ventilation of the Newborn Infant. ANZCOR April 2016 Page 2.