Does endotracheal suction prevent meconium aspiration syndrome?
ACOG update: Committee Opinion 689, March 2017
Please note that as of March 2017, ACOG has released guidance that is in accordance with AAP and AHA:
Infants with meconium-stained amniotic fluid, regardless of whether they are vigorous or not, should no longer routinely receive intrapartum suctioning. However, meconium-stained amniotic fluid is a condition that requires the notification and availability of an appropriately credentialed team with full resuscitation skills, including endotracheal intubation.
Resuscitation should follow the same principles for infants with meconium-stained fluid as for those with clear fluid
The study described below provided strong evidence in support of these guidelines.
When considering whether or not to perform endotracheal suction on a nonvigorous newborn infant in the setting of meconium stained fluid, a randomized controlled trial (RCT) found the following:
There were no significant differences between suctioned and non-suctioned newborns for the following outcomes:
Meconium aspiration syndrome, its severity and complications
Neurodevelopmental outcomes at 9 months of age
Using an RCT design, Chettri and colleagues (J Pediatr. 2015) sought to determine if endotracheal suction actually prevents meconium aspiration syndrome and its related complications.
Routine endotracheal suction does not appear to alter outcome with respect to meconium aspiration syndrome in the setting of meconium stained fluid and poor muscle tone and inadequate breathing efforts
Routine endotracheal suction is not recommended by ACOG, AAP and the AHA Guidelines due to limited evidence of benefit
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