Recent discussions
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Виктория Антонова
We agree with current recommendations. These studies reflect our current clinical experience. In my hospital we have not seen any increased incidence of MAS or PPHN with these recommendations. We have no control about long-term outcomes as they follow up in private clinics and we don't have a unified system of clinical information -
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
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. -
Виктория Антонова
I agree with the recommendation because routine suctioning of non-vigorous infants is more likely to result in delays in initiating ventilation. Thank you for reviewing the recent publications. -
Виктория Антонова
I believe in the benefit of tracheal aspiration as an important procedure in airway clearance before VPP. And based on everyday evidence, I maintain this conduct. -
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
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
This is great. I hope this translates into commonsense guidelines that will be taught both sides of the Atlantic in the same order.