Download PDF
Am J Perinatol
DOI: 10.1055/a-1950-2672
Original Article

Neonatal Outcomes since the Implementation of No Routine Endotracheal Suctioning of Meconium-Stained Nonvigorous Neonates

Mehwish Sheikh
1   Division of Neonatology, Department of Pediatrics, University of Illinois Chicago College of Medicine at Peoria, Peoria, Illinois
,
Vishakha Nanda 
2   John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
,
Rajeev Kumar
2   John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
,
Manhal Khilfeh
2   John H. Stroger, Jr. Cook County Hospital, Chicago, Illinois
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to evaluate the effect of the 2015 Neonatal Resuscitation Program recommendations of no routine endotracheal suctioning for nonvigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death.

Study Design This was a single-center retrospective cohort study. We recorded data on nonvigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n = 95 (before the new guidelines, January 1, 2013–December 31, 2015) and prospective period 2, n = 91 (after the implementation of new guidelines, January 1, 2017–December 31, 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties.

Results No significant differences in the occurrence of MAS (11 vs. 17%) (odds ratio [OR] of 1.46 [95% confidence interval [CI]: 0.59–3.55]) or death (1 vs. 3%) (OR of 2.00 [95% CI: 0.18–21.57]) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37 vs. 61%), with an OR of 2.31 (95% CI: 1.10–4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12 vs. 28%) with an OR of 2.03 (95% CI: 1.02–4.51); p-value of 0.05.

Conclusion Our study did not observe a significant difference in the incidence of MAS or death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased.

Key Points

  • Non-vigorous neonates born through MSAF who did not undergo ET suctioning soon after birth did not have increased incidence of MAS or death, but had increased NICU respiratory admissions.

  • A large Multi-center RCT may give more clear verdict on the outcomes of these newborns.

Keywords

meconium-stained amniotic fluid - nonvigorous neonate - respiratory distress - meconium aspiration syndrome - outcomes - endotracheal - suctioning at birth


Publication History

Received: 28 March 2022

Accepted: 16 September 2022

Accepted Manuscript online:
28 September 2022

Article published online:
30 December 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Lee J, Romero R, Lee KA. et al. Meconium aspiration syndrome: a role for fetal systemic inflammation. Am J Obstet Gynecol 2016; 214 (03) 366.e1-366.e9
    CrossrefPubMedGoogle Scholar
  • 2 Whitfield JM, Charsha DS, Chiruvolu A. Prevention of meconium aspiration syndrome: an update and the Baylor experience. Proc Bayl Univ Med Cent 2009; 22 (02) 128-131
    CrossrefPubMedGoogle Scholar
  • 3 Fanaroff AA. Meconium aspiration syndrome: historical aspects. J Perinatol 2008; 28 (Suppl. 03) S3-S7
    CrossrefPubMedGoogle Scholar
  • 4 Ghidini A, Spong CY. Severe meconium aspiration syndrome is not caused by aspiration of meconium. Am J Obstet Gynecol 2001; 185 (04) 931-938
    CrossrefPubMedGoogle Scholar
  • 5 Brown BL, Gleicher N. Intrauterine meconium aspiration. Obstetric Anesthesia Digest 1981; 1 (02) 37
    CrossrefPubMedGoogle Scholar
  • 6 Jovanovic R, Nguyen HT, Pearson JF. Experimental meconium aspiration in guinea pigs. Obstet Anesthes Dig 1990; 9 (04) 230
    CrossrefPubMedGoogle Scholar
  • 7 Tran N, Lowe C, Sivieri EM, Shaffer TH. Sequential effects of acute meconium obstruction on pulmonary function. Pediatr Res 1980; 14 (01) 34-38
    CrossrefPubMedGoogle Scholar
  • 8 Tyler DC, Murphy J, Cheney FW. Mechanical and chemical damage to lung tissue caused by meconium aspiration. Pediatrics 1978; 62 (04) 454-459
    CrossrefPubMedGoogle Scholar
  • 9 Wiswell TE, Gannon CM, Jacob J. et al. Delivery room management of the apparently vigorous meconium-stained neonate: results of the multicenter, international collaborative trial. Pediatrics 2000; 105 (1, pt. 1): 1-7
    CrossrefPubMedGoogle Scholar
  • 10 Kattwinkel J, Niermeyer S, Nadkarni V. et al. ILCOR advisory statement: resuscitation of the newly born infant. An advisory statement from the pediatric working group of the International Liaison Committee on Resuscitation. Circulation 1999; 99 (14) 1927-1938
    CrossrefPubMedGoogle Scholar
  • 11 Kabbur PM, Herson VC, Zaremba S, Lerer T. Have the year 2000 neonatal resuscitation program guidelines changed the delivery room management or outcome of meconium-stained infants?. J Perinatol 2005; 25 (11) 694-697
    CrossrefPubMedGoogle Scholar
  • 12 Gregory GA, Gooding CA, Phibbs RH, Tooley WH. Meconium aspiration in infants–a prospective study. J Pediatr 1974; 85 (06) 848-852
    CrossrefPubMedGoogle Scholar
  • 13 Vain NE, Szyld EG, Prudent LM, Wiswell TE, Aguilar AM, Vivas NI. Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled trial. Lancet 2004; 364 (9434): 597-602
    CrossrefPubMedGoogle Scholar
  • 14 Fraser WD, Hofmeyr J, Lede R. et al; Amnioinfusion Trial Group. Amnioinfusion for the prevention of the meconium aspiration syndrome. N Engl J Med 2005; 353 (09) 909-917
    CrossrefPubMedGoogle Scholar
  • 15 Perlman JM, Wyllie J, Kattwinkel J. et al; Neonatal Resuscitation Chapter Collaborators. Part 7: neonatal resuscitation: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. (Reprint). Pediatrics 2015; 136 (Suppl. 02) S120-S166
    CrossrefPubMedGoogle Scholar
  • 16 Wyckoff MH, Aziz K, Escobedo MB. et al. Part 13: Neonatal Resuscitation: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. (Reprint). Pediatrics 2015; 136 (Suppl. 02) S196-S218
    CrossrefPubMedGoogle Scholar
  • 17 Nangia S, Sunder S, Biswas R, Saili A. Endotracheal suction in term non vigorous meconium stained neonates-a pilot study. Resuscitation 2016; 105: 79-84
    CrossrefPubMedGoogle Scholar
  • 18 Chettri S, Adhisivam B, Bhat BV. Endotracheal suction for non-vigorous neonates born through a meconium-stained amniotic fluid: a randomized controlled trial. J Pediatr 2015; 166 (05) 1208-1213.e1
    CrossrefPubMedGoogle Scholar
  • 19 Kumar A, Kumar P, Basu S. Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial. Eur J Pediatr 2019; 178 (12) 1825-1832
    CrossrefPubMedGoogle Scholar
  • 20 Singh SN, Saxena S, Bhriguvanshi A, Kumar M, Chandrakanta S. Effect of endotracheal suctioning just after birth in non-vigorous infants born through a meconium-stained amniotic fluid: a randomized controlled trial. Clin Epidemiol Glob Health 2019; 7 (02) 165-170
    CrossrefPubMedGoogle Scholar
  • 21 Trevisanuto D, Strand ML, Kawakami MD. et al; International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis. Resuscitation 2020; 149: 117-126
    CrossrefPubMedGoogle Scholar
  • 22 Chiruvolu A, Miklis KK, Chen E, Petrey B, Desai S. Delivery room management of meconium-stained newborns and respiratory support. Pediatrics 2018; 142 (06) e20181485
    CrossrefPubMedGoogle Scholar
  • 23 Phattraprayoon N, Tangamornsuksan W, Ungtrakul T. Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106 (01) 31-38
    CrossrefPubMedGoogle Scholar
  • 24 Aldhafeeri FM, Aldhafiri FM, Bamehriz M, Al-Wassia H. Have the 2015 Neonatal Resuscitation Program guidelines changed the management and outcome of infants born through meconium-stained amniotic fluid?. Ann Saudi Med 2019; 39 (02) 87-91
    CrossrefPubMedGoogle Scholar
  • 25 Oommen VI, Ramaswamy VV, Szyld E, Roehr CC. Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106 (03) 324-326
    CrossrefPubMedGoogle Scholar
  • 26 Myers P, Gupta AG. Impact of the revised NRP meconium aspiration guidelines on term infant outcomes. Hosp Pediatr 2020; 10 (03) 295-299
    CrossrefPubMedGoogle Scholar
  • 27 Kalra VK, Lee HC, Sie L, Ratnasiri AW, Underwood MA, Lakshminrusimha S. Change in neonatal resuscitation guidelines and trends in incidence of meconium aspiration syndrome in California. J Perinatol 2020; 40 (01) 46-55
    CrossrefPubMedGoogle Scholar
  • 28 Edwards EM, Lakshminrusimha S, Ehret DEY, Horbar JD. NICU admissions for meconium aspiration syndrome before and after a national resuscitation program suctioning guideline change. Children (Basel) 2019; 6 (05) 68
    PubMedGoogle Scholar
  • 29 Kalra V, Leegwater AJ, Vadlaputi P, Garlapati P, Chawla S, Lakshminrusimha S. Neonatal outcomes of non-vigorous neonates with meconium-stained amniotic fluid before and after change in tracheal suctioning recommendation. J Perinatol 2022; 42 (06) 769-774
    CrossrefPubMedGoogle Scholar
  • 30 Kumar G, Goel S, Nangia S, Ramaswamy VV. Outcomes of non-vigorous neonates born through meconium-stained amniotic fluid after a practice change to no routine endotracheal suctioning from a developing country. Am J Perinatol 2022; (e-pub ahead of print) DOI: 10.1055/a-1797-7005.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bull World Health Organ 2007; 85 (11) 867-872
    CrossrefPubMedGoogle Scholar
  • 32 Edwards MO, Kotecha SJ, Kotecha S. Respiratory distress of the term newborn infant. Paediatr Respir Rev 2013; 14 (01) 29-36 , quiz 36–37
    CrossrefPubMedGoogle Scholar
  • 33 Warren JB, Anderson JM. Newborn respiratory disorders. Pediatr Rev 2010; 31 (12) 487-495 , quiz 496
    CrossrefPubMedGoogle Scholar
  • 34 Reuter S, Moser C, Baack M. Respiratory distress in the newborn. Pediatr Rev 2014; 35 (10) 417-428 , quiz 429
    CrossrefPubMedGoogle Scholar
  • 35 Liszewski MC, Lee EY. Neonatal lung disorders: pattern recognition approach to diagnosis. AJR Am J Roentgenol 2018; 210 (05) 964-975 DOI: 10.2214/ajr.17.19231.
    CrossrefPubMedGoogle Scholar
  • 36 Nair J, Lakshminrusimha S. Update on PPHN: mechanisms and treatment. Semin Perinatol 2014; 38 (02) 78-91
    CrossrefPubMedGoogle Scholar
  • 37 Shankaran S, Laptook AR, Ehrenkranz RA. et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
    CrossrefPubMedGoogle Scholar
  • 38 Duke T. Neonatal pneumonia in developing countries. Arch Dis Child Fetal Neonatal Ed 2005; 90 (03) F211-F219
    CrossrefPubMedGoogle Scholar
  • 39 Nissen MD. Congenital and neonatal pneumonia. Paediatr Respir Rev 2007; 8 (03) 195-203
    CrossrefPubMedGoogle Scholar
  • 40 Vayssière C, Haumonte J-B, Chantry A. et al; French College of Gynecologists and Obstetricians (CNGOF). Prolonged and post-term pregnancies: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol 2013; 169 (01) 10-16
    CrossrefPubMedGoogle Scholar
  • 41 Gülmezoglu AM, Crowther CA, Middleton P, Heatley E. Induction of labour for improving birth outcomes for women at or beyond term. Cochrane Database Syst Rev 2012; 6 (06) CD004945
    CrossrefPubMedGoogle Scholar
  • 42 Balchin I, Whittaker JC, Lamont RF, Steer PJ. Maternal and fetal characteristics associated with meconium-stained amniotic fluid. Obstet Gynecol 2011; 117 (04) 828-835
    CrossrefPubMedGoogle Scholar
  • 43 Fischer C, Rybakowski C, Ferdynus C, Sagot P, Gouyon JB. A population-based study of meconium aspiration syndrome in neonates born between 37 and 43 weeks of gestation. Int J Pediatr 2012; 2012: 321545
    CrossrefPubMedGoogle Scholar
  • 44 Wiswell TE. Handling the meconium-stained infant. Semin Neonatol 2001; 6 (03) 225-231
    CrossrefPubMedGoogle Scholar
  • 45 Gupta A, Lee HC. Revisiting the latest NRP guidelines for meconium: searching for clarity in a Murky situation. Hosp Pediatr 2020; 10 (03) 300-302
    CrossrefPubMedGoogle Scholar
  • 46 Wiswell TE. Appropriate management of the non-vigorous meconium-stained neonate: an unanswered question. Pediatrics 2018; 142 (06) e20183052
    CrossrefPubMedGoogle Scholar
  • 47 Vain NE, Musante GA, Mariani GL. Meconium stained newborns: ethics for evidence in resuscitation. J Pediatr 2015; 166 (05) 1109-1112
    CrossrefPubMedGoogle Scholar
  • 48 ROBINS-I: a tool for assessing the risk of bias in non-randomized studies of interventions. BMJ 2016; 355: i4919
    CrossrefPubMedGoogle Scholar