You might like to check out - Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomised controlled rial . ARTICLE The Lancet, Volume 364, Issue 9434, 14 August 2004, Pages 597-602 Nestor E Vain, Edgardo G Szyld, Luis M Prudent, Thomas E Wiswell, Adriana M Aguilar and Norma I Vivas
Abstract Background Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. Methods We designed a randomised controlled trial in 11 hospitals in Argentina and one in the USA. 2514 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=1263), or no suctioning before delivery (n=1251). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used. Analysis was by intention to treat. Findings 18 infants in the suction group and 15 in the no suction group did not meet entry criteria after random assignment. 87 in the suction group were not suctioned, and 26 in the no suction group were suctioned. No significant difference between treatment groups was seen in the incidence of MAS (52 [4%] suction vs 47 [4%] no suction; relative risk 0�9, 95% CI 0�6-1�3), need for mechanical ventilation for MAS (24 [2%] vs 18 [1%]; 0�8, 0�4-1�4), mortality (9 [1%] vs 4 [0�3%]; 0�4, 0�1-1�5), or in the duration of ventilation, oxygen treatment, and hospital care. Interpretation Routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation infants born through MSAF does not prevent MAS. Consideration should be given to revision of present recommendations. David ----- Original Message ----- From: "Alan Rooney" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Monday, December 06, 2004 10:27 PM Subject: RE: [ozmidwifery] Incidence of meconium > Hi Leanne > If you have a copy on suctioning on the peri I would love a copy of it. > We have a couple of doctors here who insist on suctioning on the > peri.....even if there is no mec. > > Alan > > -----Original Message----- > From: [EMAIL PROTECTED] > [mailto:[EMAIL PROTECTED] On Behalf Of leanne wynne > Sent: 06 December 2004 14:17 > To: [EMAIL PROTECTED] > Subject: Re: [ozmidwifery] Incidence of meconium > > Hi Sue, > It really is a terrific article about birthing in the caul. > I'm sure I also have an article somewhere about how suctioning the baby on > the peri actually stimulates the baby to take a breath and thus meconium is > drawn into the lungs whereas if the baby is not touched just the pressure > exerted on the baby's chest by maternal contractions will empty the lungs > ... I will do some searching ... > I can fax articles to you if you wish or send them by snail mail if that is > more convenient - let me know. > I will now go and hunt through my filing cabinet for those articles before > my next client arrives. > Leanne. > > >From: Sue Cookson <[EMAIL PROTECTED]> > >Reply-To: [EMAIL PROTECTED] > >To: <[EMAIL PROTECTED]> > >Subject: Re: [ozmidwifery] Incidence of meconium > >Date: Mon, 06 Dec 2004 12:33:30 +1100 > > > >Thanks Leanne, > >Is there any way I can access that article or acquire a copy of it - I > >don't have a membership to MIDIRS. > > > >There are certainly lots of articles now that don't support routine > >suctioning of mec-stained babies at head birth, and yet it is still > >common practice up here in the Northern Rivers Area hospitals. Any > >feedback from anyone about changing practices in hospital care? > > > >Thanks, Sue > > > > > Hi Sue, > > > An excellent article in MIDIRS Midwifery Digest 14:1 2004 by a > > > midwife > >cites > > > Houlihan and Knuppel (1994) as showing that meconium is normally > > > passed > >by > > > the foetus in 3% of cases @ <36 weeks gestation, 13% @ 36 -39 weeks > > > gestation, 19% @ 40 -41 weeks gestation and 23% @ > 41 weeks gestation. > >This > > > does not cause a problem unless the foetus becomes hypoxic. > > > Leanne. > > > > > >> From: Sue Cookson <[EMAIL PROTECTED]> > > >> Reply-To: [EMAIL PROTECTED] > > >> To: <[EMAIL PROTECTED]> > > >> Subject: [ozmidwifery] Incidence of meconium > > >> Date: Fri, 03 Dec 2004 10:30:36 +1100 > > >> > > >> Hi everyone, > > >> Just wondering if anyone has information on the incidence of > > >> meconium during labour? > > >> Anecdotally, I would say around 20%, but wonder if other's > > >> practices > >agree > > >> with this figure and if there are any statistics showing a reliable > >figure? > > >> > > >> Thanks, > > >> Sue > > >> > > >> > > > > > > > > > Leanne Wynne > > > Midwife in charge of "Women's Business" > > > Mildura Aboriginal Health Service Mob 0418 371862 > > > > > > > > > -- > > > This mailing list is sponsored by ACE Graphics. > > > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > >-- > >This mailing list is sponsored by ACE Graphics. > >Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > > Leanne Wynne > Midwife in charge of "Women's Business" > Mildura Aboriginal Health Service Mob 0418 371862 > > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > > -- > This mailing list is sponsored by ACE Graphics. > Visit <http://www.acegraphics.com.au> to subscribe or unsubscribe. > -- This mailing list is sponsored by ACE Graphics. 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