Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial

Chettri, Subhash; Adhisivam, B; Bhat, B. Vishnu

doi:10.1016/j.jpeds.2014.12.076

Cited by 105 publications

(76 citation statements)

References 37 publications

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“…45 Recent pilot trials by Nangia et al and Chettri et al have concluded that endotracheal suction does not appear to alter the incidence of MAS/death even in nonvigorous meconium-stained infants. 46,47 Further, no difference was found between two groups in other parameters like severity and duration of respiratory distress, need for respiratory support, incidence of hypoxic ischemic encephalopathy, duration of oxygen therapy, and duration of hospitalization. The most recent ILCOR guidelines 2015 thereby recommend that nonvigorous newborns with MSAF do not require routine intubation and tracheal suctioning.…”

Section: Postpartum Endotracheal Suctioningmentioning

confidence: 90%

Meconium aspiration syndrome: challenges and solutions

Goel¹,

Nangia²

2017

RRN

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Meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among term newborns. A result of antepartum or postpartum aspiration of meconium stained amniotic fluid (MSAF), MAS causes respiratory distress of varying severity, often complicated by air leaks or persistent pulmonary hypertension (PPHN). There has been a tremendous change in the concepts of pathophysiology and management of MAS over the last few decades. Routine endotracheal suctioning is no longer recommended in both vigorous and nonvigorous neonates with MSAF. Supportive management, along with newer therapies such as surfactant, inhaled nitric oxide, and high-frequency ventilation, has resulted in marked improvement in the overall outcome of MAS. The present review highlights the challenges in understanding the complex pathophysiology and optimal management approach to MAS. Potential future therapies and drugs in trial are also discussed briefly.

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Section: Postpartum Endotracheal Suctioningmentioning

confidence: 90%

Meconium aspiration syndrome: challenges and solutions

Goel¹,

Nangia²

2017

RRN

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“…[107][108][109][110][111][112][113][114][115][116] Appropriate intervention to support ventilation and oxygenation should be initiated as indicated for each individual infant. This may include intubation and suction if the airway is obstructed.…”

Section: Nrp 865mentioning

confidence: 99%

Part 13: Neonatal Resuscitation

Wyckoff¹,

Aziz²,

Escobedo³

et al. 2015

Circulation

615

344

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“…One small randomized study has addressed the question of prophylactic endotracheal suctioning in the depressed baby with meconium 17 (see NRP 865), and 1 randomized trial of sustained inflation (SI) has recently been published 18 (see NRP 804). Additional studies addressing these critical questions are ongoing but were not available for the 2015 CoSTR review.…”

Section: Generation Of Topicsmentioning

confidence: 99%

“…For the critical outcome of mortality and/or meconium aspiration syndrome (MAS), we identified 1 randomized study involving 122 infants (low-quality evidence, downgraded for risk of bias and imprecision) 17 comparing tracheal intubation for suctioning versus no tracheal intubation for suctioning in nonvigorous infants showing no benefit to suctioning in either reduced mortality and/or MAS.…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 7: Neonatal Resuscitation

Perlman¹,

Wyllie²,

Kattwinkel³

et al. 2015

Circulation

533

256

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The transition from intrauterine to extrauterine life that occurs at the time of birth requires timely anatomic and physiologic adjustments to achieve the conversion from placental gas exchange to pulmonary respiration. This transition is brought about by initiation of air breathing and cessation of the placental circulation. Air breathing initiates marked relaxation of pulmonary vascular resistance, with considerable increase in pulmonary blood flow and increased return of now-welloxygenated blood to the left atrium and left ventricle, as well as increased left ventricular output. Removal of the lowresistance placental circuit will increase systemic vascular resistance and blood pressure and reduce right-to-left shunting across the ductus arteriosus. The systemic organs must equally and quickly adjust to the dramatic increase in blood pressure and oxygen exposure. Similarly, intrauterine thermostability must be replaced by neonatal thermoregulation with its inherent increase in oxygen consumption.Approximately 85% of babies born at term will initiate spontaneous respirations within 10 to 30 seconds of birth, an additional 10% will respond during drying and stimulation, approximately 3% will initiate respirations after positive-pressure ventilation (PPV), 2% will be intubated to support respiratory function, and 0.1% will require chest compressions and/or epinephrine to achieve this transition. [1][2][3] Although the vast majority of newborn infants do not require intervention to make these transitional changes, the large number of births worldwide means that many infants require some assistance to achieve cardiorespiratory stability each year.Newly born infants who are breathing or crying and have good tone immediately after birth must be dried and kept warm so as to avoid hypothermia. These actions can be provided with the baby lying on the mother's chest and should not require separation of mother and baby. This does not preclude the need for clinical assessment of the baby. For the approximately 5% of newly born infants who do not initiate respiratory effort after stimulation by drying, and providing warmth to avoid hypothermia, 1 or more of the following actions should be undertaken: providing effective ventilation with a face mask or endotracheal intubation, and administration of chest compressions with or without intravenous medications or volume expansion for those with a persistent heart rate less than 60/min or asystole, despite strategies to achieve effective ventilation (Figure 1).The 2 vital signs that are used to identify the need for an intervention as well as to assess the response to interventions are heart rate and respirations. Progression down the algorithm should proceed only after successful completion of each step, the most critical being effective ventilation. A period of only approximately 60 seconds after birth is allotted to complete each of the first 2 steps, ie, determination of heart rate and institution of effective ventilation. Subsequent progression to the next step will depend o...

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Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial

Cited by 105 publications

References 37 publications

Meconium aspiration syndrome: challenges and solutions

Meconium aspiration syndrome: challenges and solutions

Part 13: Neonatal Resuscitation

Part 7: Neonatal Resuscitation

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