Effect of endotracheal suctioning just after birth in non-vigorous infants born through meconium stained amniotic fluid: A randomized controlled trial

Background Depressed neonates born through meconium stained amniotic fluid (MSAF) are at high risk for developing meconium aspiration syndrome (MAS). Benefits and risk of endotracheal suctioning in non-vigorous infants at birth, though widely practiced till recent have not been established. Objectives To evaluate effect of endotracheal suctioning at birth on incidence of MAS, its severity and outcome among non-vigorous MSAF born infants. Methods This randomized open level trial was conducted over one year period at a tertiary care teaching hospital. 155 non-vigorous infants (vigour assessed within 5–10s of birth) were randomized to receive either endotracheal (ET) suctioning just after birth (n=76) or no-endotracheal suction (n=79). Subsequent resuscitation was performed as per neonatal resuscitation guideline. All infants were admitted for subsequent care and monitoring. Antenatal, intrapartum, and neonatal details; respiratory support; complications, hospital stay and outcome were recorded. Results Incidence of respiratory distress due to MAS (with consistent chest radiology) was 41.3% and 57.1% [OR=0.53(0.28to 1.01); p=0.052], while non-MAS respiratory distress was 33.3% and 27.3% [OR=1.69(0.81 to 3.54); p=0.17] in ET suction and no-ET suction group, respectively. Severity of MAS in ET suction vs. no-ET suction group were mild:16.1%(5/31)vs15.9%(7/44); moderate:61.3%(19/31)vs65.9%(29/44) and severe:22.6%(7/31)vs18.2% (8/44). Respiratory support requirement including mechanical ventilation; its duration, and mortality were similar in both groups, however, hospital stay was shorter in ET suction group (9.91±3.22vs. 11.17±3.73days; mean diff:−1.26(−3.36 to −0.17); p=0.024). Conclusions Endotracheal suctioning at birth in non-vigorous infants born through MSAF tends to decrease the incidence of MAS and duration of hospital stay, however, overall incidence of respiratory distress and mortality remain unchanged.