Meconium Aspiration in Infants. A Prospective Study

Meconium aspiration syndrome: historical aspects

“…With the evidence-based approach to prevention of MAS and the initiation of better less-invasive therapies, including inhaled nitric oxide, surfactant therapy, surfactant lavage and various modes of mechanical ventilation, including high-frequency ventilation, it is rare for an infant to require ECMO for MAS. [13][14][15][16] Evidence-based practice to prevent MAS On the basis of the evidence from non-randomized studies, [6][7][8] to reduce the incidence and severity of MAS the recommendation was to intubate and suction all babies born through thick meconium. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary.…”

“…6 Rationale for routine endotracheal intubation to prevent MAS The foundations for routine endotracheal intubation of infants for MSAF was based on what today would be considered entirely anecdotal evidence. Gregory et al 7 wished to document the prevalence of MSAF, the nature of the MSAF (thick or watery, thick but still liquid, particulate) and the incidence of respiratory distress when there was meconium present. In a prospective collection of data they reported MSAF in 8.8% of 1000 consecutive newborn infants over a 6 month time period.…”

“…They aspirated the upper and lower airways as soon as possible 'sometimes before the first breath' in 80 of the 88 infants with MSAF. 7 If the trachea contained meconium, intubation and suctioning were repeated until the airway had been cleared. Fifty-seven infants had meconium in their mouth, 62 had meconium in the stomach and 8 had meconium in the trachea but none in the mouth or larynx.…”

“…On the basis of these studies by Gregory, 7 Ting 8 and Carson, 9 the commonest approach to MSAF, whether thick, watery or particulate, was for the obstetrician to immediately suction the nasopharynx as soon as the head appeared on the perineum. Thereafter, visualization of the cords by direct laryngoscopy and suctioning of the trachea through the endotracheal tube if meconium was detected was the routine adopted at most centers.…”

Neonatal resuscitation guidelines for ILCOR and NRP: evaluating the evidence and developing a consensus

“…For the first 46 months (period 1), the standard had been not to perform intrapartum suctioning, but to perform direct endotracheal suctioning of all meconium-stained babies after delivery. This post-delivery practice had been initiated following the observation of Gregory et al 10 in 1974 that 56% of meconium-stained neonates had meconium recovered from below the cords. For the next 10 months (period 2), Carson et al performed intrapartum suctioning, continued to suction the trachea immediately following birth, and then performed a tracheobronchial lavage with normal saline.…”