Appropriate Management of the Nonvigorous Meconium-Stained Neonate: An Unanswered Question

* Abbreviations: ILCOR — : International Liaison Committee on Resuscitation MAS — : meconium aspiration syndrome MSAF — : meconium-stained amniotic fluid RCT — : randomized controlled trial In this issue of Pediatrics , Chiruvolu et al1 compare outcomes in infants who are nonvigorous and meconium stained from before and after a recent recommendation was made not to routinely intubate and suction such infants. They found that not performing this procedure resulted in significantly more NICU respiratory admissions as well as an increased requirement for oxygen, mechanical ventilation, and surfactant therapy. Of infants diagnosed with meconium aspiration syndrome (MAS), infants who were not intubated had longer durations of oxygen and mechanical ventilation and longer lengths of stay. Was the recommended management change made too hastily? The presence of meconium-stained amniotic fluid (MSAF) is associated with adverse outcomes.2 Approximately 10% to 15% of all newborns are born through MSAF, with 3% to 9% of them developing MAS and other respiratory disorders. Approximately 20% of infants born through MSAF are nonvigorous and are considerably more likely to have respiratory distress and adverse outcomes. Of term infants admitted to NICUs, 4% to 5% have MAS.3 In 1960, routine intubation and suctioning of neonates born through MSAF was first suggested.4 Three reports published in the mid-1970s revealed better outcomes among infants born through MSAF who had this intervention.5–7 Subsequently, the procedure was widely practiced. In a review … Address correspondence to Thomas E. Wiswell, MD, 2623 Lower Kula Rd, Kula, HI 96790. E-mail: Thomas.E.Wiswell{at}kp.org