Consensus on Science with Treatment Recommendations (CoSTR)
Sook Kyung Yum
I think routine laryngoscopy with or without intubation is not necessarily a "must-be-done-immediately" procedure in the non-vigorous newborns with MSAF, but current recommendation somewhat sounds as if this procedure should be strongly restricted. There is not enough scientific evidence that can support this recommendation as a one-fits-all methodology in various delivery settings around the world. In hospitals with experts in intubation procedure, there would be not much delay in establishing adequate PPV. Rather, in some circumstances, PPV without suctioning way exacerbate airway obstructions. Hence the recommendation should be more clear on the possibility for case-by-case decision, and present laryngoscopy with or without intubation as an acceptable (though not routine) option.
Concordo com as novas recomendações. Tambem não vimos nenhum aumento da incidência de MAS ou HPP com elas. Acredito que sucção rotineira de lactentes não vigorosos após a aspiração de mecônio pode ser realizada uma vez e, tanto a sucção traqueal quanto a intubação devem ser analisadas caso a caso.
Interesting findings and this certainly reflects the available data and prompts for a more thorough study to be done. I am torn as a therapist (RRT) as I have been in the NICU environment 26 years now and I have seen good outcomes from both sets of guidelines (latter vs present) I think that a judgement call at the bedside must be made depending on so many variables. This critical thinking skill is declining over time with the next generation of therapists, nurses and yes, physicians. I support more investigation and data, as evidence based guidelines have been working well so far, let's keep it moving forward and put recommendations together that don't "can" the practice of delivering babies.