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Comparison of neonatal outcomes of term neonates with meconium-stained amniotic fluid before and after routine endotracheal suctioning strategy at birth

Journal of Perinatology (2026)Cite this article

Subjects

Abstract

Objectives

To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous neonates.

Methods

We conducted a multicenter retrospective cohort study across three centers comparing two eras. Neonates born through MSAF at ≥36 weeks’ gestation were included. Multivariable regression adjusted for sex and birth center.

Results

Among 8635 neonates (5554 Era 1; 3081 Era 2), including 1053 non-vigorous neonates, unadjusted MAS incidence did not differ between eras overall (4.8% vs. 5.5%, p = 0.17) or among non-vigorous neonates (21.0% vs. 22.8%, p = 0.55). After adjustment, Era 2 was associated with higher odds of MAS overall (aOR 1.37, 95% CI 1.11–1.69) and among non-vigorous neonates (aOR 1.54, 95% CI 1.07–2.22). Respiratory distress was higher in Era 2, while other outcomes assessed were unchanged.

Conclusions

Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.

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Data availability

The datasets generated or analyzed during this study are not publicly accessible due to institutional data use agreements and patient confidentiality obligations. However, these data may be obtained from the corresponding author upon reasonable request and contingent on appropriate approvals.

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Funding

The study was funded by the Ashok and Ingrid Sarnaik Faculty Research Endowment Grant at Children’s Hospital of Michigan. The study sponsors did not have any role in the design, interpretation, or analysis of the data. Ashok and Ingrid Sarnaik Faculty Research Endowment Grant, Children’s Hospital of Michigan, Detroit, USA. All authors have indicated they have no financial relationships relevant to this article to disclose.

Author information

Author notes

  1. Unaffiliated: Thomas Wiswell.

Authors and Affiliations

  1. Department of Pediatrics, Central Michigan University, Wayne State University, Detroit, MI, USA

    Sanjay Chawla, Praveen Kumar Boddu & Kanika Deora

  2. Department of Pediatrics, Duke University, Durham, NC, USA

    Rachel G. Greenberg

  3. Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA

    Anup Katheria & Katherine Coughlin

  4. Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Gary Weiner

  5. Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA

    Henry C. Lee

  6. Department of Pediatrics, Kaiser Permanente, San Leandro, CA, USA

    Vaneet Kalra

  7. Department of Pediatrics, Baylor University Medical Center at Dallas, Dallas, TX, USA

    Arpitha Chiruvolu

  8. Department of Pediatrics, University of California at Davis Children’s Hospital, Sacramento, CA, USA

    Satyan Lakshminrusimha

Authors
  1. Sanjay Chawla
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  2. Rachel G. Greenberg
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Contributions

Sanjay Chawla developed the protocol, created the data collection form, reviewed the analysis, and drafted the first version of the manuscript. Rachel G. Greenberg, MB, MHS: Contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Praveen Kumar contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Anup Katheria contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Katherine Coughlin contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Kanika Deora contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Gary Weiner contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Henry Lee contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Vaneet Kalra contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Arpitha Chiruvolu contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Thomas Wiswell contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. Satyan Lakshminrusimha contributed to the conception and design, reviewed the protocol, contributed to the analysis, and revised the manuscript critically. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Sanjay Chawla.

Ethics declarations

Competing interests

Dr. Lakshminrusimha is a member of the Editorial Board of J of Perinatology. There is no other potential conflict of interest, real or perceived, in the conduct of this study. All study authors were involved in the collection of data, review of the manuscript, and the decision to submit this manuscript to the Journal of Perinatology. No honorarium, grant, or payment was provided to anyone to produce this manuscript.

Ethics approval and consent to participate

This multicenter retrospective study was conducted in strict adherence to all applicable guidelines and regulations. Institutional Review Board (IRB) approval was secured from each participating site (Duke Health IRB: Pro00101971; University of California, Davis: IRB1367680-1; Wayne State University: IRB104218MP2E; Sharp Center for Research: IRB00000920). In view of the retrospective nature of the study and the use of de-identified data, the requirement for informed consent was formally waived by the respective IRBs.

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Chawla, S., Greenberg, R.G., Boddu, P.K. et al. Comparison of neonatal outcomes of term neonates with meconium-stained amniotic fluid before and after routine endotracheal suctioning strategy at birth. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02636-7

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