Recent discussions
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Виктория Антонова
I believe that even thought the evidence is not what we would like for these types of recommendations in neonatal resuscitation, and working with newborns in a middle income country (Colombia) as a neonatologist for the past 25 years were we do have a high amount of meconium stained liquid, the recommendation of not aspirating and starting positive pressure ventilation has been easier for us in clinical practice and in training, and we have better outcomes in our babies. -
Виктория Антонова
concordo que a ventilação inicial antes da aspiração direta da traqueia ,para aqueles que não têm boa prática de intubação, num bebê instável deve ser sempre considerada, porém nos bebês ativos,deve-se aspirar apenas o orofaringe. aguardamos novas recomendações. -
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
A aspiração traqueal não é um procedimento rápido em mãos pouco experientes. E isso pode retardar a ventilação e reanimação, além de traumática. O mecônio pode ser aspirado apenas em Via Aéreas Superiores, como outras secreções, de acordo com os passos iniciais, facilitando e auxiliando o início da ventilação. Em casos específicos, com secreção muito espessa que esteja atrapalhando a ventilação, ai sim, aspiração traqueal. Acredito que as recomendações atuais ainda são pertinentes. -
Виктория Антонова
Agree with the wording in this document. Appreciate that the team has well revised the available data. This is not a simple issue, but erring on the safe side as this is worded is good for me. Thank you! -
Виктория Антонова
I think that just a one suction with laringoscopy before resuscitation provide a better ventilation with less obstruction of airways -
Виктория Антонова
I thank CoSTR for attempting to wrap our heads around how to approach a non-vigorous infant that is meconium-stained. HOWEVER, what we fail to do in each individual case is to assess the degree of meconium airway obstruction on first glance, that needs to be overcome quickly to proceed with air exchange. How is that done ? Only by direct laryngoscopy and suctioning if necessary, by a skilled and efficient intubator ! Since the only people well-trained enough are skilled practitioners( MD, RN, RRT'S) that are familiar and efficient at quick intubations, we are left making separate recommendations for those of us who can get in and out before delaying precious time to get air exchange going, and those of us who are not that efficient. I have struggled with how to approach this in the best way to be fair to both, but must admit there is none. If you need to ventilate, even though you are blowing meconium down an airway, I must accept the fact that this will cause much less CNS damage and morbidity in the long run than making less-skilled intubators struggle with clearing an airway for the best respiratory outcome - am I making sense ? -
Виктория Антонова
The routine suctioning of non-vigorous infants after meconium aspiration can be perfomed once and both, tracheal suction and intubation must be a priority in these cases . The same like Rita. -
Виктория Антонова
Agree that the wording and recommendations appear to be an accurate reflection of the current state of evidence. Well done. -
Виктория Антонова
Agree with the authors. Tracheal suctioning delays resuscitation in the babies that needs it the most.