From National
Womens Hospital NZ. www.adhb.govt.nz/newborn/Guidelines/Admission/MeconiumStainedLiquorAndMAS.htm -
Delivery
Room Management
- The Paediatric Resident (SHO, Registrar, or
NS-ANP) should be called if there is thick meconium staining or light
meconium plus fetal distress.
- There is no advantage in oral and pharyngeal
suction as the head delivers and this is no longer indicated. 1
Suctioning does not alter the chance of developing respiratory distress or
symptomatic meconium aspiration syndrome, even in sub-groups with thick
meconium, fetal distress or delivered by Caesarean section.
- If the baby is apparently vigorous at birth
(heart rate >100, spontaneous respiration, reasonable tone), intubation
and tracheal suction is not indicated, unless the baby subsequently has
poor respiratory effort or early respiratory distress. 2
Intubation of vigorous babies does not improve respiratory
outcomes and can result in trauma to the infant.
- Intubation and tracheal suction should be
performed if the baby has moderate or thick meconium and depression at
birth.
Meconium stained amniotic fluid (MSAF) occurs in about 12% of
deliveries. Meconium aspiration is defined by meconium aspirated from
below the vocal cords. However, Meconium Aspiration Syndrome (MAS)
defines a wide array of respiratory symptoms associated with MSAF. MAS usually
presents as respiratory distress and cyanosis. Pulmonary hypertension is
common.
www.cs.nsw.gov.au/rpa/neonatal/html/newprot/Meconium.htm - Royal Prince Alfred Hospital: Meconium staining of the amniotic fluid
(MSAF) is found in approximately 15% of pregnancies. MSAF rarely occurs before
38 weeks' gestation. The incidence of this condition increases with longer
gestations and approximately 30% of newborns have MSAF at 42 weeks.2
Several
lines of evidence challenge the concept that aspiration of meconium is
responsible for severe MAS and suggest that other events cause the syndrome,
with meconium in the lungs as an co- incidental finding.3, 4 The
passage of meconium in utero may be a response to stresses such as chronic
hypoxia, acidaemia or infection, processes that may interfere with clearing of
meconium.1 Post
delivery prevention of MAS used to be focussed on adequate suctioning. It was
believed that diligent suctioning of the fetal oropharynx and trachea at
delivery could decrease the rate of MAS. However, recent randomized studies
showed no reduction of severe MAS with early oropharyngeal suctioning and/or
endotracheal suctioning of the trachea.7, 8, 9
Paediatric
staff should be present at deliveries where there is thick meconium staining of
the liquour or where there is evidence of fetal distress. A multicentre
randomised controlled trial found there was no advantage in oral and pharyngeal
suction as the head delivers. 8
Yet, the Royal Womens says:www.rwh.org.au/nets/handbook/index.cfm?doc_id=459
At both vaginal and
operative deliveries perform thorough suctioning of the mouth and pharynx after
delivery of the head and before delivery of the shoulders. Guide the catheter
into the posterior pharynx via a finger inserted into the infant’s mouth.
Use a size 12Fr catheter set at –100mmHg. Repeat the procedure until no
further meconium is obtained.
