Recent discussions
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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. -
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
I agree not to perform tracheal aspiration if the airways are not obstructed. In our delivery room care experience, many colleagues wasted time attempting intubation, delaying the onset of positive pressure ventilation, and worsening the neonate's neurological prognosis. -
Виктория Антонова
Agree with current recommendations. We have not seen any increased incidence of MAS or PPHN with these recommendations -
Виктория Антонова
I agree to immediate resuscitation without direct laryngoscopy. -
Виктория Антонова
Agree with the authors' recommendations based on the evidence available thus far. Appreciate the clarification offered by Jonathan Wyllie: "recommendations and guidelines do not preclude experts making treatment decisions appropriate to individual cases as long as they can be justified". -
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?