The Need for Delivery Room Intubation of Thin Meconium in the Low-Risk Newborn: A Clinical Trial

Abstract

The delivery room management of meconium-stained amniotic fluid remains controversial. We attempted to determine if intubation of the low-risk newborn with thin meconium affects the incidence of respiratory symptoms. Exclusion criterion included moderate or thick meconium, fetal distress, neonatal depression, or prematurity. Eligible infants were randomized to either an intubation (group I) or to a nonintubation group (group II). The outcome was the presence of respiratory symptoms. Patients were studied from May 1994 to June 1997. There were 8967 births during this period: 7.9% (708/8967) were delivered through meconium. Thin meconium was noted in 50.3% (356/708) of all births. 24/356 infants with thin meconium were excluded for medical criterion. One hundred sixty-three infants were medically eligible but could not be randomized due to lack of consent, late arrival of the team, or obstetrician request. These were placed into intubation (group I B) and nonintubation (group II B) groups. Seventy-seven infants were randomized into group I and 92 infants into group II. From the intubation groups I and I B, one required supplemental oxygen and was weaned to room air in 7 hr. From the nonintubation groups II and II B, two infants required oxygen, weaning to room air in 11 and 46 hr. Comparing birth weight, gestational age, sex, mode of delivery and 5-min Apgar, there were no significant differences. However, the intubation groups had significantly lower 1-min Apgar scores. There was no airway morbidity reported in the intubation groups. In the infant with thin meconium and an otherwise low-risk pregnancy, we were unable to demonstrate a difference in respiratory symptoms with intubation and intratracheal suctioning.

Have the Year 2000 Neonatal Resuscitation Program Guidelines Changed the Delivery Room Management or Outcome of Meconium-Stained Infants?

“…Our study is consistent with previous reports documenting no significant increase in the rate of MA or other respiratory complications following a selective approach to tracheal suctioning. 1,[14][15][16][17][18][19][20][21] Although there was an insignificant trend toward more MA in period 2 (1.3%) compared to period 1 (0.85%) ( p ¼ NS), this was offset by a reduction in incidence of RD-other in period 2 (1.4%) compared to period 1 (1.9%) ( p ¼ NS). Further, there was no change in the rate of MA or RD-other in the sub-group of ''vigorous'' infants.…”

Delivery Room Risk Factors for Meconium Aspiration Syndrome

“…This was primarily initiated to cover the subset of the cohort that was involved in a randomized trial. 13…”

“…A subgroup of these babies, born through thin MSAF, may or may not have been intubated based upon enrollment in a contemporaneous clinical trial. 13 MAS was the primary outcome. Initially, we looked at all respiratory symptoms, with respiratory symptoms defined as tachypnea, (respiratory rate >60), with or without grunting or retractions.…”

Airway Management and Mask Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010

“…Routine endotracheal suctioning of babies who have meconium stained liquor, and who are vigorous (breathing or crying, good muscle tone), is discouraged because it does not alter their outcome and may cause harm [Class A, LOE II 5,6 ] Observational studies suggest that depressed infants born with meconium stained amniotic fluid are at increased risk to develop MAS [LOE IV 7,8 ]. However, for non-vigorous infants, available evidence does not support or refute the value of routine endotracheal suctioning in preventing MAS.…”