Recent discussions
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Виктория Антонова
Agree with author's recommendations. It would be useful to clarify that all nonvigorous infants with meconium should be gently suctioned to remove meconium from oropharynx and hypopharynx before stimulation, using the suction method that is within the scope of practice of the individual providing care to the infant. This may be performed with a suction catheter, bulb syringe in the cheek, or ET based on clinical experience and competence. When intubation is obviously needed for the most depressed neonates then brief suctioning can be done prn if there is visible meconium to allow clear passage of an ET tube as needed for optimal ventilation. Many practitioners practice in community settings and nurses may be the first to begin the initial steps. This clarification based on scope of practice and competency can aid in directing actions in each clinical setting. The key message is that all non-breathing infants (meconium and clear fluid) should be suctioned before PPV, with suctioning being brief and gentle, and followed by the rest of the initial steps before initiation of PPV. -
Виктория Антонова
In my point of view , there aren’t scientific evicences that the procedure of intubation/suction is inadequate. Therefore I’ll continue practicing the current recommended methodology -
Виктория Антонова
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. -
Виктория Антонова
I agree with the recommendation, as the wording leaves room for individual assessment while removing the idea of routine. -
Виктория Антонова
I think more prospective studies should be necessary to show more outcomes. Ventilation is the most important thing to the newborn, but if the meconium is obstructive, i think it should be suctioned. -
Виктория Антонова
This is great. I hope this translates into commonsense guidelines that will be taught both sides of the Atlantic in the same order. -
Виктория Антонова
I agree with the recommendation. I would like to see an analysis stratifying for the size of the centre where the resuscitation happened. Based on the comments posted I see that the common theme is the presence or not of an experienced resuscitator. The frequency with which such resuscitator performs the tracheal intubation to keep the skill adds weight to the recommendation of proceeding with PPV after clearing the mouth particularly in small centres. Although I have no data to support this comment. -
Виктория Антонова
Agree with the recommendation although I do have a concern with loss of clinical skills. Another question is regarding blind (oral/nasal) suctioning for babies born through mec: should suctioning be done at the moment of birth, after being brought to warmer, after attempting PPV as part of MR SOPA or just in order to visualize the cords if baby need to be intubated? -
Виктория Антонова
I agree with the new recommendations. For a procedure to be considered routine there needs to be evidence of benefits. In this case, aside from having no benefit, it may delay the start of ventilation, the benefit of which has been clearly established. I also agree with the authors' decision to consider individualized management of tracheal aspiration in some cases, since the available evidence on the topic are either of low or very low quality. -
Виктория Антонова
First of all I want to thanks colleagues who carried out this important job. The limited availability of sized RCTs makes difficult to sustain firm recommendations on this topic. However, I think that the suggestion against routine immediate direct laryngoscopy in non-vigorous infants after delivery with or without tracheal suctioning can be accepted on the basis of current evidences. In fact, when we speak of "routine" laryngoscopy we do not exclude that it can be performed in particular situations (i.e.: in severely ill patients or in case of particulate meconium ) that could be detailed in local protocol taking into account the local experience of personnel.