Management of meconium stained infants

From: Lori Nelson (lnelson44@hotmail.com)
Tue, 29 Jan 2002 08:25:12 -0600 (CST)

My name is Lori Nelson. I am a nursing student from the University of North Dakota. I am interested in the delivery room management of meconium stained infants. According to Wiswell, Gannon, Jacob, and Goldsmith (2000), reports published during the 70's suggested that all meconium stained infants undergo intratrachial suctioning to prevent meconium aspiration syndrome. During the decade after the reports surfaced, the strategy of intubation and suctioning meconium stained infants was widely adopted. Consequently, the incidence of meconium stained aspiration syndrome and deaths related to it declined. These reports were based solely on observational, not controlled studies. According to Huffman (2000), during the late 80's, reports surfaced regarding the harmful effects of intratrachial suctioning, suggesting that all meconium stained infants may not need it. To investigate this debate, Wiswell et al. (2000) conducted a randomized controlled trial to determine the effects of intubation and suctioning as they relate to decreasing the incidence of MAS and as they relate to complications from the treatment.Criteria for this Wiswell et al. study was: 1)gestational age >7 weeks; 2)birth through meconium stained amniotic fluid of any consistency; 3)apparent vigor (heart rate >100 beats per minute, presence of spontaneous movement and or some degree of extremity flexion) assessed within the first 10 to 15 seconds after delivery. Infants, at random, were either intubated immediately after birth (once meeting criteria for vigor) and suctioned with a standard meconium suction device -or- they received only standard delivery room care (suctioning of oropharynx with either catheter to wall suction or bulb syringe before delivery of shoulder and trunk--which was done to all infants). From results of that study, Wiswell et al. concluded that intratrachial suctioning did not result in a decreased incidence of respiratory distress when compared with the infants who received only standard delivery room care. In addition, they found complications from intubation were relatively low and minor. Their concluding statement also includes: "until proven otherwise, endotracheal intubation and suctioning should still be performed in infants born through meconium stained anmiotic fluid if they are not vigorous..." The effects of meconium are well documented. According to Davis and Shekerdemian (2001), respiration after birth draws meconium into the major airways...and with succeeding respirations...into the smaller airways. If the complications of intubation are minor and effects of meconium aspiration severe...why wait until an infant meets criteria defined as nonvigorous to intubate? I would very much appreciate any more information on this topic. Thank you, Lori Nelson, College of Nursing, University of North Dakota.

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