Intrapartum events were studied in 272 patients with meconium-stained amniotic fluid. All infants underwent DeLee suction followed by intubation and 58 of 272 had meconium present below the vocal cords at delivery. Neither the total duration of variable fetal heart rate decelerations or a continuous saltatory pattern nor the presence or absence of late decelerations could be related to an increased risk of meconium below the vocal cords. When a rising baseline fetal heart rate and decreased variability were present as well, a significantly greater proportion of patients had meconium below the vocal cords. Routine obstetric and pediatric suctioning did not prevent the single death that occurred in a fetus who had deep meconium aspiration in utero.
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[The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years].
Zhongguo Dang Dai Er Ke Za Zhi
March 2023
Department of Neonatology, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong 518000, China/Stollery Philip C. Etches NICU at Royal Alexandra Hospital, University of Alberta, Edmonton, Canada.
Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery.
View Article and Find Full Text PDFTracheal suction at birth in non-vigorous neonates born through meconium-stained amniotic fluid.
Cochrane Database Syst Rev
June 2021
Department of Neonatology, Government Medical College and Hospital, Chandigarh, India.
Background: Neonates born through meconium-stained amniotic fluid (MSAF) are at risk of developing meconium aspiration syndrome (MAS). Neonates who are non-vigorous due to intrapartum asphyxia are at higher risk of developing MAS. Clearance of meconium from the airways below the vocal cords by tracheal suction before initiating other steps of resuscitation may reduce the risk of development of MAS.
View Article and Find Full Text PDFEmergency Department Vacuum Extraction of an Obstructing Tracheal Foreign Body Using a Meconium Aspirator and Modified Endotracheal Tube.
J Emerg Med
April 2021
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Background: A meconium aspirator is a simple plastic adapter that allows for rapid suctioning of the trachea when attached to an endotracheal tube and a source of continuous negative pressure, as was historically done for suspected neonatal meconium aspiration. Adaptation of this technique for the emergent vacuum extraction of an obstructing tracheal foreign body in an adult has not been previously described.
Case Report: We report the case of a 33-year-old woman with cardiorespiratory arrest after choking on food.
Trainees success rates with intubation to suction meconium at birth.
Arch Dis Child Fetal Neonatal Ed
September 2018
Department of Pediatrics, Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Objectives: To assess the success rate and main reasons for failure of intubation performed by medical trainees to suction meconium below the vocal cords in non-vigorous infants delivered at ≥36 week gestation.
Design: We conducted a prospective cohort study involving 54 residents and nine neonatology fellows in a Canadian level 3 neonatal intensive care unit. Endotracheal intubation to suction meconium was performed using a videolaryngoscope, the video screen being covered during the procedure.
Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?
Am J Perinatol
July 2018
Department of Pediatrics, University of California, Davis, California.
Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades.
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