Research Article
Volume 10 Issue 12 - 2021
Meconium is a Mess. Prudence and Equipoise in the Delivery Room when Caring for Non-Vigorous Neonates with Thick Meconium in the Amniotic Fluid

Augusto Sola1*, Susana Rodríguez2, Lourdes Lemus Varela3, Anamaría Bravo Ramírez4 and Victoria Lima5

1Director Iberoamerican Society of Neonatology (SIBEN), Miami, Florida, USA
2Scientific Director Iberoamerican Society of Neonatology (SIBEN), Director of Research and Education, Hospital Juan P Garrahan, Buenos Aires, Argentina
3Iberoamerican Society of Neonatology (SIBEN) and Neonatal Intensive Care Unit, Centro Médico Nacional de Occidente IMSS, Guadalajara Jalisco, México
4Research and Educational Department, Hospital Central Doctor Inacio Morones Prieto, y Universidad Autónoma de San Luis Potosí, México
5Neonatal Intensive Care Unit, Hospital Central Doctor Ignacio Morones Prieto San Luis Potosí and Universidad Autónoma de San Luis Potosí, México
*Corresponding Author: Augusto Sola, Director Iberoamerican Society of Neonatology (SIBEN), Miami, Florida, USA.
Received: November 10, 2021; Published: November 30, 2021


Background: Meconium is the normal bowel movement of newborn babies during the first few days; it sometimes “makes a real mess”. On the other hand, meconium passed in utero could be serious. Meconium-stained amniotic fluid (MSAF) could be of different consistency or texture and can occurs from 5% of all births to as high as 22%. Meconium aspiration syndrome (MAS) is a heterogenous condition with wide spectrum of severity. It could be estimated that around 1,600,000 newborns will have MAS worldwide and about 5 - 12% of them die. We can find more than 2,000 publications on this topic, but the appropriate management of the non-vigorous neonate with thick MSAF is still an unanswered question. Some of the publications and recommendations of the last decade have led to confusion of some practitioners and it has created a mess for them and for the sick babies and their families.

Objective: To raise nonjudgmental awareness and attention to current issues related to airway management in the delivery room of non-vigorous newborns with thick or “pea soup” meconium.

Methods: Analyze recommendations, recent studies and randomized controlled trials (RCT) focusing specifically on the findings reported for airway management in the delivery room (DR) of non-vigorous infants born with thick meconium in the amniotic fluid and briefly explore the responses of 1,265 neonatal health care professionals regarding their practices in the DR for such infants.

Results: Several changes have occurred in the recommendations made for the management of the airway in infants born through MSAF. Many publications include in the denominator all newborns with MSAF of any consistency and there are few publications that specify the MASF texture and/or separate clearly the findings specifically for non-vigorous infants with thick meconium. There is significant variability in airway management for these infants in the DR.

Conclusion: The majority of babies born through MSAF do not need endotracheal tube suctioning (ETS). However, there is a need for a large, high-quality RCT of ETS with a sufficient sample size of non-vigorous infants born through thick meconium to better inform on future decision making in order to tidy up “the current mess”.

Keywords: Meconium-Stained Amniotic Fluid; Meconium Aspiration Syndrome; Randomized Controlled Trials; Delivery Room


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Citation: Augusto Sola., et al. “Meconium is a Mess. Prudence and Equipoise in the Delivery Room when Caring for Non-Vigorous Neonates with Thick Meconium in the Amniotic Fluid”. EC Paediatrics 10.12 (2021): 113-119.

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