Influence of the legal imperative and medical guidelines on the incidence and management of the meconium-stained newborn.

Abstract

Following a legal action that resulted from the death of a newborn with the meconium aspiration syndrome, I investigated the incidence and management at a community hospital of the meconium-stained newborn during March in each of the years 1973 through 1985. During March in 1973 through 1981, 4.3% of all live births (1368) were meconium stained. After the newborn's death, which initiated a period of legal negotiations, the incidence of meconium staining increased to 14.4% among 582 live births during March of 1982 through 1985. Laryngoscopy increased to include 64.3% of meconium-stained newborns, and endotracheal suctioning was associated with laryngoscopy in 72.2% of the patients. Also, oxygen administration to newborns with and without meconium staining increased from 10.5% in March of 1973 through 1981 to 45.7% in March of 1982 through 1985. There was no improvement in outcome from the increased recognition and more aggressive management. While the issuance of medical guidelines alone had little effect on the incidence and care of the meconium-stained newborn, the combination of the legal imperative with medical guidelines had a profound and corruptive effect.