Retrospectively Assessed Muscle Tone and Skin Colour following Airway Suctioning in Video-Recorded Infants Receiving Delivery Room Positive Pressure Ventilation

Abstract

Background: Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO2) and 10 min Apgar score. The aim of this study was to examine the effect of delivery room airway suctioning on the clinical appearance, including muscle tone and skin colour, of video-recorded term and preterm infants born through mainly clear amniotic fluid. Methods: This was a single-centre observational study using transcribed video recordings of neonatal stabilizations. All infants who received delivery room positive pressure ventilation (PPV) from August 2014 to November 2016 were included. The primary outcome was the effect of airway suctioning on muscle tone and skin colour (rated 0–2 according to the Apgar score), while the secondary outcome was the fraction of infants for whom airway suction preceded the initiation of PPV as a surrogate for “routine” airway suctioning. Results: Airway suctioning was performed in 159 out of 302 video recordings and stimulated a vigorous cry in 47 (29.6%) infants, resulting in improvements in muscle tone (p = 0.09) and skin colour (p < 0.001). In 43 (27.0%) infants, airway suctioning preceded the initiation of PPV. Conclusions: In this single-centre observational study, airway suctioning stimulated a vigorous cry with resulting improvements in muscle tone and skin colour. Airway suctioning was often performed prior to the initiation of PPV, indicating a practice of routine suctioning and guideline non-compliance.

Video-Recorded Airway Suctioning of Clear and Meconium-Stained Amniotic Fluid and Associated Short-Term Outcomes in Moderately and Severely Depressed Preterm and Term Infants

“…Fawke et al [29] described no clinical benefit, and some evidence for desaturations resulting from suctioning clear amniotic fluid in vigorous infants. Several studies have described apnoea, bradycardia, and delays in achieving normal saturations in relation to airway suctioning [1,15,17,18,30,36,37]. In our study, spontaneous respiration was unchanged after the majority of ASU episodes in preterm infants and improved after almost three quarters of the ASU episodes in term infants.…”

“…In our study, spontaneous respiration was unchanged after the majority of ASU episodes in preterm infants and improved after almost three quarters of the ASU episodes in term infants. The impact of the depth of the suctioning on spontaneous respiration and HR is mentioned in the studies of Cavalin et al [30], Purington et al [24], and Fawke et al [19]. In our study, the preterm infants underwent both deeper and longer duration suctioning compared to the term infants.…”

“…All staff received instruction in assisted ventilation and adhered to the guidelines for neonatal resuscitation from the Norwegian Resuscitation Council [18], which were derived from the ILCOR, European Resuscitation Council, and Australian and New Zealand Committee on Resuscitation guidelines. Training specifically emphasized updates to the guidelines, particularly those that de-emphasized the use of ASU [30].…”

“…This paper reports data from some transcripts previously reported in [30,32,33]. The primary purpose of the assembled data was to evaluate the effect of "high-frequency, short-span" simulations with facilitator-led debriefings where the video logs were used for learning and quality improvement.…”