scholarly journals Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial

2020 ◽  
Vol 180 (1) ◽  
pp. 247-252
Author(s):  
Francesco Cavallin ◽  
Giulia Res ◽  
Chiara Monfredini ◽  
Nicoletta Doglioni ◽  
Paolo Ernesto Villani ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Amniotic Fluid ◽  
Clinical Setting ◽  
Positive Pressure Ventilation ◽  
Mean Difference ◽  
Positive Pressure ◽  
Endotracheal Suctioning ◽  
Pediatric Residents ◽  
Tracheal Suctioning ◽  
Meconium Stained Amniotic Fluid

AbstractTracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid (MSAF) is supposed to delay initiation of positive pressure ventilation (PPV), but the magnitude of such delay is unknown. To compare the time of PPV initiation when performing immediate laryngoscopy with intubation and suctioning vs. performing immediate PPV without intubation in a manikin model. Randomized controlled crossover (AB/BA) trial comparing PPV initiation with or without endotracheal suctioning in a manikin model of non-vigorous neonates born through MSAF. Participants were 20 neonatologists and 20 pediatric residents trained in advanced airway management. Timing of PPV initiation was longer with vs. without endotracheal suctioning in both pediatric residents (mean difference 13 s, 95% confidence interval 8 to 18 s; p < 0.0001) and neonatologists (mean difference 12 s, 95% confidence interval 8 to 16 s; p < 0.0001). The difference in timing of PPV initiation was similar between pediatric residents and neonatologists (mean difference − 1 s, 95% confidence interval − 7 to 6 s; p = 0.85).Conclusions: Performing immediate laryngoscopy with intubation and suctioning was associated with longer—but not clinically relevant—time of initiation of PPV compared with immediate PPV without intubation in a manikin model. While suggesting negligible delay in starting PPV, further studies in a clinical setting are warranted.Registration: clinicaltrial.gov NCT04076189. What is Known:• Management of the non-vigorous newborn delivered through meconium-stained amniotic fluid remains still controversial.• Tracheal suctioning in non-vigorous newborn delivered through meconium-stained amniotic fluid is supposed to delay initiation of positive pressure ventilation, but the magnitude of such delay is unknown.What is New:• Performing immediate ventilation without intubation was associated with shorter—but not clinically relevant—time of initiation of ventilation compared to immediate laryngoscopy with intubation and suctioning in a manikin model.• Further studies in a clinical setting are warranted.

Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?

2018 ◽  
Vol 35 (09) ◽  
pp. 815-822 ◽  
Author(s):  
Sushma Nangia ◽  
Praveen Chandrasekharan ◽  
Satyan Lakshminrusimha ◽  
Munmun Rawat
Keyword(s):  
Amniotic Fluid ◽  
Neonatal Intensive Care ◽  
Positive Pressure Ventilation ◽  
Neonatal Resuscitation ◽  
Meconium Aspiration Syndrome ◽  
Positive Pressure ◽  
Randomized Controlled Studies ◽  
Randomized Control ◽  
Meconium Stained Amniotic Fluid ◽  
Ischemic Encephalopathy

AbstractMeconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.

Modified Apparatus for Aspiration of Meconium from the Airway

PEDIATRICS ◽  
1982 ◽  
Vol 70 (2) ◽  
pp. 307-308
Author(s):  
Louis E. Fazen
Keyword(s):  
Amniotic Fluid ◽  
Endotracheal Tube ◽  
Direct Laryngoscopy ◽  
Standard Treatment ◽  
Endotracheal Suctioning ◽  
Suction Control ◽  
Meconium Stained Amniotic Fluid

The standard treatment for the newborn with meconium-stained amniotic fluid consists of prompt visualization of the pharynx, hypopharynx, and trachea and suction of any meconium fluid present.1 This report describes a simple, inexpensive apparatus to facilitate the suctioning of meconium under direct laryngoscopy (Figure). The modified apparatus consists of a plastic adapter from an adult red rubber bronchial aspirating catheter (Davol bronchial aspirating catheter with suction control, Davol, Inc, Providence, RI) attached to a standard pediatric endotracheal tube. The 3.5-cm sized endotracheal tube has a large enough bore for suctioning the pharynx and hypopharynx and can also be used for endotracheal suctioning.

Risk of Neonatal Short-Term Adverse Outcomes Associated with Noninfectious Intrapartum Hyperthermia: A Nested Case-Control Retrospective Study

2019 ◽  
Author(s):  
Hao Zhu ◽  
Jiangnan Wu ◽  
Yijia Yang ◽  
Xiaotian Li ◽  
Rong Hu
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Amniotic Fluid ◽  
Induction Of Labor ◽  
Adverse Outcomes ◽  
Neonatal Outcomes ◽  
Positive Pressure ◽  
Neonatal Infections ◽  
Adverse Neonatal Outcomes ◽  
Meconium Stained Amniotic Fluid

Abstract Objective Aim of this study was to identify risk factors for adverse neonatal outcomes in neonates born to mothers with noninfectious intrapartum hyperthermia. Study Design A retrospective study was conducted of 460 singleton deliveries diagnosed with noninfectious intrapartum hyperthermia. Logistic regression was used to estimate the association between ante- and intrapartum risk factors and neonatal outcomes. Results The 460 singleton pregnant women were 19 to 43 years of age. They developed an intrapartum temperature of ≥37.5°C somewhere between 340/7 to 414/7 weeks' gestation; 437 (95%) were nulliparous. Meconium-stained amniotic fluid was associated with positive pressure ventilation or intubation ventilation (odds ratio [OR] = 5.940, 95% confidence interval [CI]: 2.038–17.318), birth depression (OR = 6.288, 95% CI: 2.273–17.399), and wet lung (OR = 2.747, 95% CI: 1.322–5.709). Induction of labor with artificial rupture of membranes (AROM; OR = 2.632, 95% CI: 1.325–5.228) was associated with neonatal infections. Maternal temperature ≥ 38°C was associated with neonate's artery blood gas pH < 7.3 (OR = 2.366, 95%CI: 1.067–5.246) and wet lung (OR = 2.909, 95% CI: 1.515–5.586). Maternal elevated C-reactive protein (CRP) was associated with neonatal infections (OR = 1.993, 95% CI: 1.260–3.154) and wet lung (OR = 2.600, 95% CI: 1.306–5.178). Conclusion Meconium-stained amniotic fluid, induction of labor, maternal temperature ≥ 38°C, and elevated CRP during labor were risk factors for adverse neonatal outcomes.

scholarly journals Outcomes of endotracheal suctioning in non-vigorous neonates born through meconium-stained amniotic fluid: a systematic review and meta-analysis

2020 ◽  
Vol 106 (1) ◽  
pp. 31-38
Author(s):  
Nanthida Phattraprayoon ◽  
Wimonchat Tangamornsuksan ◽  
Teerapat Ungtrakul
Keyword(s):  
Systematic Review ◽  
Amniotic Fluid ◽  
Outcome Measures ◽  
Perinatal Asphyxia ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Endotracheal Suctioning ◽  
Significant Difference ◽  
The Impact ◽  
Meconium Stained Amniotic Fluid

ObjectiveWe aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates.DesignWe conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF.Main outcome measuresThe primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay.ResultsA total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35).ConclusionsInitiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.

Meconium and Tracheal Aspiration

PEDIATRICS ◽  
1992 ◽  
Vol 90 (3) ◽  
pp. 475-475
Author(s):  
DAVID W. REYNOLDS
Keyword(s):  
Amniotic Fluid ◽  
Retrospective Analysis ◽  
Medical Center ◽  
Meconium Aspiration Syndrome ◽  
Positive Pressure ◽  
Walter Reed Army Medical ◽  
Meconium Aspiration ◽  
Army Medical ◽  
Meconium Stained Amniotic Fluid ◽  
Tracheal Aspiration

To the Editor.— Based on a retrospective analysis of neonates born at Walter Reed Army Medical Center from 1985 through 1989 with meconium-stained amniotic fluid (MSAF), Drs Wiswell and Henley conclude that all such newborns should have their tracheas suctioned immediately after birth.1 This study was undertaken primanly to address the recommendation of Cunningham et al that intratracheal aspiration be reserved for babies requiring positive pressure resuscitation.2 Although Wiswell and Henley found a significantly higher incidence of meconium aspiration syndrome (MAS) in all nonsuctioned neonates (12/133) compared with all suctioned neonates (24/608), this was clearly not true for babies with thin meconium.

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