ArticlesOropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial
Introduction
An important complication in newborn infants born through meconium-stained amniotic fluid (MSAF) is the development of meconium aspiration syndrome (MAS).1, 2 Limited anecdotal data have led to the widespread practice of intrapartum oropharyngeal and nasopharyngeal suctioning of meconium-stained infants in the presence of MSAF.3 However, other data do not support this approach.4, 5 Nonetheless, this procedure is practised worldwide for millions of deliveries complicated by MSAF every year.6, 7
Additionally, prominent organisations such as the International Liaision Committee on Resuscitation, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists have recommended the procedure.6, 8, 9 Although it is no longer advocated in the UK Newborn Life Support Guidelines (Resuscitation Council),10 prenatal suction of meconium-stained infants is still frequently undertaken.
However, no randomised controlled trial so far has specifically assessed the effectiveness of intrapartum oropharyngeal and nasopharyngeal suctioning in the prevention of MAS in deliveries complicated by MSAF. Since intrapartum suctioning has potential risks, the need for assessment of this widely practised procedure should not be ignored.1, 4, 5
We aimed to assess the effectiveness of intrapartum oropharyngeal and nasopharyngeal suctioning compared with no suctioning in the prevention of MAS and its complications.
Section snippets
Patients
12 centres participated in our multicentre, randomised controlled trial: 11 in Argentina, and one in the USA. Trial sites included six public hospitals caring for patients from underserved populations who often failed to seek prenatal care, and six private hospitals that care for women of middle and upper socioeconomic classes who received high-quality health care. Patients were enrolled between March 13, 2000, and Oct 1, 2001. Enrolment did not start on the same day in all centres during this
Results
During the study, 3249 patients met inclusion criteria (figure). Of these, 735 were not enrolled because of: (1) insufficient time for a randomisation envelope to be opened (n=539) due to factors such as delayed notification of MSAF, or MSAF only being noted at the time of uterine incision during a caesarean section; (2) refusal by the obstetrician to allow his or her patient to participate (n=126); and (3) other reasons (n=70), mostly due to technical difficulties in the suction system that
Discussion
In our randomised controlled trial of term-gestation infants born through MSAF, intrapartum suctioning did not decrease the incidence of MAS. Other important outcomes, including mortality, air leaks, duration of mechanical ventilation, oxygen treatment, or length of hospital stay, were similarly unaffected by this procedure. In our trial, infants at highest risk for MAS (ie, those born through the thickest-consistency MSAF, with fetal distress, delivered via caesarean section, and needing
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