Intrapartum oropharyngeal and nasopharyngeal suctioning in neonates born through meconium-stained amniotic fluid: Indian scenario

Abstract

Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS.Methods: A prospective quasi randomized control trial, assessor blind, single centre study was done at Department of neonatology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan. Patients were enrolled over a total period of 16 months started from January 2016 to April 2017. 312 patients with MSAF of any consistency, gestational age at least 37 weeks, and cephalic presentation were randomly assigned to suctioning of the oropharynx and nasopharynx (including the hypopharynx) before delivery of the shoulders (n=127), or no suctioning before delivery (n=185). Postnatal delivery-room management followed Neonatal Resuscitation Program guidelines. The primary outcome was incidence of MAS. Clinicians diagnosing the syndrome and designating other study outcomes were masked to group assignment. An informed consent waiver was used.Results: No significant difference between treatment groups was seen in the incidence of MAS [36 (26.7%) suction versus 36 (19.5%) no suction; p = 0.167], mortality in suction [5 (3.91%) versus no suction 5 (2.74%); p = 0.779], or in the duration of ventilation, oxygen treatment, and hospital care. There was statistically significant difference in need for mechanical ventilation for MAS [13 (10.23%) vs 4 (2.2%); p = 0.005], any respiratory support for MAS 25 (19.7%) suction versus 18 (9.7) p = 0.019).Conclusions: Routine intrapartum suctioning of infants born through MSAF does not reduce the incidence of MAS. On the contrary, intrapartum suctioning might result in complications like more infant required neonatal resuscitation and respiratory support.