Recent discussions
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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. -
Виктория Антонова
I agree to immediate resuscitation without direct laryngoscopy. -
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.