ABSTRACT
The delivery room management of meconium-stained amniotic fluid remains controversial.
We attempted to determine if intubation of the low-risk newborn with thin meconium
affects the incidence of respiratory symptoms. Exclusion criterion included moderate
or thick meconium, fetal distress, neonatal depression, or prematurity. Eligible infants
were randomized to either an intubation (group I) or to a nonintubation group (group
II). The outcome was the presence of respiratory symptoms. Patients were studied from
May 1994 to June 1997. There were 8967 births during this period: 7.9% (708/8967)
were delivered through meconium. Thin meconium was noted in 50.3% (356/708) of all
births. 24/356 infants with thin meconium were excluded for medical criterion. One
hundred sixty-three infants were medically eligible but could not be randomized due
to lack of consent, late arrival of the team, or obstetrician request. These were
placed into intubation (group I B) and nonintubation (group II B) groups. Seventy-seven
infants were randomized into group I and 92 infants into group II. From the intubation
groups I and I B, one required supplemental oxygen and was weaned to room air in 7
hr. From the nonintubation groups II and II B, two infants required oxygen, weaning
to room air in 11 and 46 hr. Comparing birth weight, gestational age, sex, mode of
delivery and 5-min Apgar, there were no significant differences. However, the intubation
groups had significantly lower 1-rmin Apgar scores. There was no airway morbidity
reported in the intubation groups. In the infant with thin meconium and an otherwise
low-risk pregnancy, we were unable to demonstrate a difference in respiratory symptoms
with intubation and intratracheal suctioning.
Keywords
Thin meconium - meconium aspiration - intubation - intratracheal suctioning - Apgar
scores
