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It’s Not Just Meconium . . .

These data support the neonatal resuscitation guideline recommending endotracheal intubation and suctioning only for infants who are nonvigorous at birth.

The neonatal resuscitation program (NRP) guidelines for infants born through meconium-stained amniotic fluid (MSAF) were revised in 2000 from routine endotracheal intubation and suctioning to selective intubation and suctioning only for neonates who are not vigorous at birth. Investigators at a single institution in Connecticut retrospectively evaluated the delivery room management and outcomes of term infants (gestational age, 37 weeks) before and after the guideline change.

The numbers of live births during the 3 years before and the 3 years after the guideline change were 12,927 and 11,718, respectively. Birth through MSAF occurred in 13.6% of deliveries before the change and in 13.1% afterward. The percentage of babies with thick or thin meconium did not differ during the two periods. Significantly more babies with MSAF were intubated before the guideline change than after the change (67% vs. 41%). Factors that were significantly associated with intubation were Apgar scores of 0 to 7, thickness of meconium (thick vs. thin), and year of birth (before vs. after the guideline change). Among infants born through MSAF, the incidences of meconium aspiration syndrome during the two time periods were statistically similar (0.85% before vs. 1.30% after). The incidence of respiratory distress from other than MSFA was 1.9% before and 1.4% after. Ten babies in both periods required mechanical ventilation. The authors concluded that since the guideline change, the percentage of babies who receive intubation has dropped with no change in respiratory complications.

Comment: These data support the change in the neonatal resuscitation program guideline in 2000 from routine to selective endotracheal intubation and suctioning for nonvigorous births. The results also show that invasive procedures such as intubation that are associated with risks can be reduced without an increase in respiratory distress. However, because many intubated neonates did not meet criteria for intubation based on the new NRP guidelines, we still have work to do to improve outcomes in such infants.

— William P. Kanto, Jr., MD

Published in Journal Watch Pediatrics and Adolescent Medicine January 12, 2006

Citation(s):

Kabbur PM et al. Have the year 2000 neonatal resuscitation program guidelines changed the delivery room management or outcome of meconium-stained infants? J Perinatol 2005 Nov; 25:694-7.

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