Recent discussions
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Виктория Антонова
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. -
Виктория Антонова
In fact I have our own opinion and I gave lectures in China, japan and in Europe. My opinion is based on physiology and not by clinical data, because the clinical data usually based on a lot of variation in: who resuscitate the baby, resident, attending, nurse, with different experience, in particular, the experience with endotracheal intubation. As you know, majority of the infant aspirated meconium before birth, many infants are born by C-section and already have MAS right after birth. Only small proportion, and perhaps, insignificant amount of Meconium aspirated during the second stage of labor. Once meconium already aspirated, it is essential to do ET suction and clean the upper airway as early as possible because meconium would migrate to periphery, e.g. in 2-3 hours with respiration, as seen in animal experiment regardless if there is a vigorous or non-vigorous. In fact, with vigorous cry, it may even enhance the migration speed of meconium to periphery. Thus, it will even cause more problem because if meconium migrate to periphery, respiration will get worse. Therefore, we recommend, if baby has respiratory distress shortly after birth, suggesting aspiration, we do recommend ET suction as soon as possible after birth regardless if he infant is vigorous or not. Of course, ET intubation should be done by person with experience so that cyanosis or bradycardia will not occur. There are two papers, and one chapter from my book clearly demonstrated this. (Neonatal Med 2017 May;24(2):53-61. . NeoReviews 2010;11:e503-e12. ) If my suggestion is well taken, please cite my paper as credit. -
Виктория Антонова
we observed no difference in outcome after we stopped aspirating trachea in these babies. -
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
I agree with the finding and support the new recommendation from the group. This will make infants safer and have less trauma related to intubation. Thank you for always supporting the smallest patients. -
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. -
Виктория Антонова
Agree with the author's recommendations. Now it's up to NRP and other educational programs to figure out how to incorporate these recommendations in the resuscitation algorithm. Since we move away from routine intubation and suctioning, some practitioners wonder if the practice of routine oropharyngeal suctioning either at perineum or soon after delivery should be reevaluated. Although some studies showed no benefit in then past, they were conducted in an era where routine intubation and tracheal suctioning were routine. Thanks! -
Виктория Антонова
Good Work: The limited evidence available still doesn't support laryngoscopy and routine tracheal suctioning for non vigorous infants with mec stained fluid. But there are still unanswered questions regarding suctioning: should non vigorous infants born through meconium be suctioned (mouth and nose-blind) at the moment of birth, or after being brought to warmer or after attempting PPV as part of MRSOPA? Or should oral suction be limited to what ever is required to visualise the cords during intubation?