Gastric Suctioning to Prevent Iatrogenic Meconium Aspiration

To the Editor.

The Manual for the Neonatal Resuscitation Program (NRP)¹ suggests that the mouth, pharynx, and nose of the newborn and not the stomach be suctioned before delivery of the shoulders, when meconium staining is present. It is suggested that one wait until the infant has been fully resuscitated and vital signs are stable before suctioning the stomach. The reason given for this delay is that the chance of producing a vagal response with apnea and bradycardia will be minimized.

In reviewing the literature, it is difficult to find evidence that gastric suctioning per se causes bradycardia in the fetus and newborn. There is evidence that nasopharyngeal² and tracheal suctioning³ can cause bradycardia in the newborn. However, when thick meconium is present in the amniotic fluid, most authorities agree that upper airway and tracheal suctioning of the newborn are reasonable to prevent or minimize meconium aspiration. Because there is such a risk of morbidity and mortality from meconium aspiration, would it not also be reasonable to empty the stomach before endotracheal intubation is performed?

Anesthesiologists perform elective intubation in patients who have been fasted for more than eight hours to minimize the …