Selective tracheal suctioning to prevent meconium aspiration syndrome

Abstract

Adequate obstetrical cleansing of the upper airway in vigorous babies may obviate the need for endotracheal intubation; intubation of depressed babies following this treatment may be useful.

Part 15: Neonatal Resuscitation

“…27 Although depressed infants born to mothers with meconium-stained amniotic fluid (MSAF) are at increased risk to develop MAS, 28,29 tracheal suctioning has not been associated with reduction in the incidence of MAS or mortality in these infants. 30,31 The only evidence that direct tracheal suctioning of meconium may be of value was based on comparison of suctioned babies with historic controls, and there was apparent selection bias in the group of intubated babies included in those studies. [32][33][34] In the absence of randomized, controlled trials, there is insufficient evidence to recommend a change in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid (Class IIb, LOE C).…”

Part 7: Neonatal Resuscitation

“…For the critical outcome of mortality and/or MAS, we identified very-lowquality evidence from 3 studies [158][159][160] including 12 389 MSAF infants showing higher incidence of MAS in depressed infants (268/1022, 26%) who had tracheal intubation for suctioning compared with vigorous infants (34/11 367, 0.3%) who were not intubated (downgraded for indirectness).…”

Part 11: Neonatal Resuscitation

“…Although these infants are at increased risk of developing meconium aspiration syndrome, the use of tracheal suctioning has not been associated with a reduction in the incidence of meconium aspiration syndrome or mortality (LOE 4 26 ; LOE 5 27 ). No randomized controlled studies have compared intubation and tracheal suctioning and no tracheal suctioning in depressed infants.…”