Meconium-stained Liquor and Meconium Aspiration
|Reviewed by Clinical Practice Committee|
|Delivery Room Management||Further Management||Criteria for Admission to NICU|
|Management of the Symptomatic Infant||Complications of Meconium Aspiration||References|
- 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
- Intubation of vigorous babies does not improve respiratory outcomes and can result in trauma to the infant as well as inducing apnoea.
- 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
- Emphasis should be made on initiating ventilation rapidly in non-breathing or ineffectively breathing infants.
- If tracheal suction is performed:
- Only by a clinician experienced at intubation
- Do not stimulate the baby to breathe prior to suction
- Suction promptly, before giving any respiratory support
- Intubate and suction the ETT using a large bore suction catheter. Do not remove the ETT (unless blocked with particulate meconium) as the priority is to obtain a secure airway and provide effective ventilation.
- Do not repeat intubation for suctioning
- If pharyngeal suction is required to remove meconium obstructing the airway, it must be under direct vision e.g. using a laryngoscope.
|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.|