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PEDIATRICS Vol. 105 No. 1 January 2000, pp. 1-7
Received Feb 11, 1999; accepted Apr 26, 1999.
,
,,
From the Neonatology services at * Thomas Jefferson University,
Philadelphia, Pennsylvania; Providence Alaska Medical Center,
Anchorage, Alaska; § West Jersey Hospital, Voorhees, New Jersey;
Diego Paroissien Hospital, Buenos Aires, Argentina; ¶ Mercer Medical
Center, Trenton, New Jersey; # Fitzgerald Mercy Hospital, Darby,
Pennsylvania; ** Flushing Hospital, Flushing, New York; University
Hospital, Buenos Aires, Argentina; §§ Clinicas Hospital,
Asúncion, Paraguay; || Pennsylvania Hospital, Philadelphia,
Pennsylvania; ¶¶ Desert Samaritan Medical Center, Phoenix, Arizona;
and ## Scott and White Memorial Hospital, Temple, Texas.
Objective. Disagreement exists concerning the appropriate delivery room management of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such neonates, whereas others advocate a selective approach. We performed this investigation: 1) to assess whether intubation and suctioning of apparently vigorous, meconium-stained neonates would reduce the incidence of meconium aspiration syndrome (MAS); and 2) to determine the frequency of complications from delivery room intubation and suctioning of such infants.
Methods. Inclusion criteria included: 1) gestational age
37 weeks; 2) birth through meconium-stained amniotic fluid of any consistency; and 3) apparent vigor immediately after birth. Subjects were randomized to be intubated and suctioned (INT) or to expectant management (EXP). Primary outcome measures included: 1) the incidence of respiratory distress, including MAS, and 2) the incidence of complications from intubation.
Results. A total of 2094 neonates were enrolled from 12 participating centers (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demonstrated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings attributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the development of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 successfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in nature.
Conclusions. Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived.
Key words: meconium aspiration syndrome, newborn infant, intubation.
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