What (not) to do at and after delivery? Prevention and management of meconium aspiration syndrome

Meconium aspiration syndrome: challenges and solutions

“…Over the last decade, interventions such as elective reduction of post-term births, aggressive management of fetal distress, and reduced incidence of birth asphyxia have resulted in a significant decline in MAS incidence. 31 Elective induction of labor at 41 weeks of gestation prevents maturation-induced meconium passage and possible asphyxia because of failing placental function resulting in secondary MAS. A recent Cochrane review of 19 trials showed that elective induction at 41 weeks of gestation reduced the risk of perinatal mortality with lower incidence of MAS in the induced group (relative risk: 0.29, 95% CI: 0.12-0.68).…”

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

“…13 The efficacy of endotracheal suctioning for nonvigorous meconium stained neonates has not been evaluated. 3,6,8,9,[14][15][16] Complications of intubation include apnea, bradycardia, upper airway injury, vocal cord dislocation, bleeding, hoarseness, and stridor. 10 Intubation may also delay the initiation of positive pressure ventilation, which may be critical to reverse asphyxia and stabilize the neonate.…”

When Is Waiver of Consent Appropriate in a Neonatal Clinical Trial?

“…[3][4][5] The presumed benefits of immediate tracheal suctioning are inferred from observational studies using historical controls reported in the 1970s. 6 The trial would be augmented if neurologic andpulmonary outcomesat2 years could be assessed.…”

“…According to Vain et al, "Use of unproven policies and practices should not be perpetuated and proper testing of emergency procedures will result in improved medical care." 3 Both studies led to changes in standard practices regarding newborns with MSAF. The proposed protocol carries no more risk to its subjects than did the previous protocols for which consent was waived.…”