SHOULD WE STICK TO THE PRACTICE OF SUCTIONING NEWBORNS (NB) BORN THROUGH MECONIUM STAINED AMNIOTIC FLUID (MSAF)?

Abstract

Since Gregory showed that the Meconium Aspiration Syndrome (MAS) decreased with tracheal suctioning, this has become standard practice. Recently it has been suggested that suctioning should be done only in depressed NB who require positive pressure ventilation, since vigorous NB will not have meconium (mec) below the vocal cords (VC) and will threrefore, not aspirate. However, we have seen vigorous NB developing MAS. The present retrospective study was undertaken to establish if in our Unit, the indication of universal suctioning of NB with MSAF is still valid. Clinical records of all NB with MSAF FROM 1/89 through 12/92, were retrospectively reviewed. The following variables were analyzed: 1 minute (A1) and 5 minute (A5) Apgar Scores, mec thickness, presence of mec below VC, complications of intubation, and incidence of MAS. Of 2923 consecutive biths, 203 had MSAF (5); 19/203 had A1 =< 3 and 5/19 had A5 =< 5, all had thick mec bellow VC, all were suctioned, 3 developed MAS. Of the vigorous NB, 92 had mec below VC, 21/92 had thick mec; all were suctioned and none developed MAS. There were no complications due to intubation. These data show that in both depressed and vigorous NB, mec can be found below VC. We speculate that suctioning vigorous NB prevented MAS. We conclude that until further conclusive date are available, the possibility of aspiration and MAS is present in vigorous NB and that all infants born through MSAF especially if mec is thick, should be suctioned to prevent MAS.

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