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Evolution of Delivery Room Management for Meconium-Stained Infants

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Chabra, Shilpi, MD

Section Editor(s): Harris-Haman, Pamela A. DNP, CRNP, NNP-BC; ; Zukowsky, Ksenia PhD, APRN, NNP-BC;

doi: 10.1097/ANC.0000000000000522
Clinical Issues in Neonatal Care

Background: The approach to intrapartum and postnatal management of an infant born through meconium-stained amniotic fluid (MSAF) in the delivery room (DR) has changed several times over the last few decades, leading to confusion and anxiety among health care providers (nurses, nurse practitioners, respiratory therapists, midwives, and physicians). This article provides state-of-the-art insight into the evidence or lack thereof for the changes in guidelines.

Purpose: To discuss the evidence for evolution of DR management of vigorous and nonvigorous infants born through any type of MSAF.

Methods: Review of guidelines from the Neonatal Resuscitation Program of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, the International Liaison Committee on Resuscitation, Consensus on Science and Treatment Recommendations, and textbooks of neonatal resuscitation and research using MEDLINE via PubMed.

Findings: In pregnancies complicated by MSAF, intrapartum suctioning of the oro- and nasopharynx and postnatal intubation with tracheal suctioning of infants have been traditionally used to clear the airway and decrease meconium aspiration syndrome. The recommendations for these perinatal practices have changed several times due to some evidence that the procedures are not beneficial and may even be harmful.

Implications for Practice: Intrapartum suctioning and postnatal tracheal suctioning of infants (vigorous or nonvigorous) born through MSAF are not recommended. This is a “high-risk” delivery requiring 2 team members to be present at birth—one with full resuscitation skills including tracheal intubation.

Implications for Research: Need to evaluate effects of discontinuing the practice of tracheal suctioning in nonvigorous infants on the incidence of meconium aspiration syndrome and neonatal mortality.

Division of Neonatology, Department of Pediatrics, University of Washington, Seattle.

Correspondence: Shilpi Chabra, MD, Division of Neonatology, Department of Pediatrics, University of Washington, 1959 NE Pacific St, Box 356320, Seattle, WA 98195 (

The author declares no conflict of interest.

© 2018 by The National Association of Neonatal Nurses