Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country

Gunjana Kumar; Srishti Goel; Sushma Nangia; Viraraghavan Vadakkencherry Ramaswamy

doi:10.1055/a-1797-7005

American Journal of Perinatology, Table of Contents

Am J Perinatol 2024; 41(09): 1163-1170
DOI: 10.1055/a-1797-7005

Original Article

Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country

Gunjana Kumar

¹Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India

,

Srishti Goel

¹Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India

,

Sushma Nangia

¹Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India

,

Viraraghavan Vadakkencherry Ramaswamy

²Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India

› Author Affiliations

Abstract

Objective The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation.

Study Design This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271).

Results Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser.

Conclusion Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed.

Key Points

Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS.
Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak.
Large multicentric trial is required to generate robust evidence.

Keywords

meconium aspiration syndrome - nonvigorous neonate - delivery room resuscitation - endotracheal suction - meconium-stained amniotic fluid

Full Text

References

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