Recent discussions
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Виктория Антонова
I fully agree with the CoSTAR and a prima facie position of primum non nocere, until there is evidence that an invasive intervention is actually beneficial. One minor point; "cognitive" is preferred to "mental" development. -
Виктория Антонова
After 33 yearas of neonatal doctor the recommendation for "no tracheal suctioning" was not a good. for me at least one suction pass was best and then intubation if necessary . But as Susan posted above NO suctioning IS vertiam a bad idea for non-vigorous infants with thick meconium. I suggest That The recommendation should be for one tracheal suction pass, and then intubation if needed. Os clean that Will be Several passes delaying intubation and possibly not clear the airway that much better,. AGAIN no suctioning is not a good practice. -
Виктория Антонова
I completely agree here. I postulate the vagal effect of suctioning and post delivery direct tracheal intervention only worsens the low heart rate, making it more difficult for the infant to recover. -
Виктория Антонова
There still appears to be quite divergent opinions on tracheal suctioning of the meconium- stained non-vigorous infant due to experience and the relative paucity of newer data. Having been a pediatrician for almost 30 years, I have taken part in many such resuscitations and a small number of babies required tracheal suctioning of meconium to be able to move any air into and out of the lungs. Despite the small number, it truly made a difference in those instances. A statement should be added that when you reach intubation due to lack of response of your initial resuscitation and obstruction is apparent that suctioning should be done prior to providing PPV through the ETT, preferably using a meconium aspirator connection. -
Виктория Антонова
Meconium visualization laryngoscopy and it´s rapid aspiration facilitated resuscitation. We observed in our service that professionals continued to aspirate trachea without delaying the resuscitation result. I particularly adopted the practice of not aspirating trachea and observed that its evolution was more pronounced in the NICU. We had an increase in the milder cases of meconium aspiration syndromes. I disagree with the new guidelines on postponing tracheal aspiration in these cases. -
Виктория Антонова
Thank you for going through this investigative process. As an RN of 37 years and a NRP instructor for 25 years I agree. I am employed in a large University Medical Center and not using tracheal visualization/suctioning of non-vigorous infants (MAS babies) has not changed outcomes. If a MAS infant was placed on ECHMO there were also other factors contributing to this procedure. -
Виктория Антонова
Thank you to all the colleagues who have already commented and to those who intend to do so. The the ILCOR Neonatal task force will look at all comments made. We intend to derive themes from comments and subsequently review and revise as appropriate based on the themes raised and the evidence quoted. However, the whole purpose of the ILCOR/GRADE process has always been to assess the available evidence. We are not able to make changes based upon anecdote, although recommendations and guidelines do not preclude experts making treatment decisions appropriate to individual cases as long as they can be justified. Again thank you all for this great feedback and engagement. Jonathan Wyllie Vice Chair Neonatal Task Force -
Виктория Антонова
I do think it is important to emphasize the importance of suctioning via ET tube during MR SOPA corrective steps in infants delivered trough meconium stained fluid, even if we will not routinely intubate to suction prior to any other resuscitative measures. -
Виктория Антонова
It appears that there is no benefit for the use of immediate laryngoscopy with or without tracheal suctioning when compared to immediate resuscitation without laryngoscopy after reviewing the data that is available. -
Виктория Антонова
The science and current clinical trials are insufficient to make the recommendation of NO intubation and suctioning of a non vigorous infant. With a NRP provider who is skilled at intubation there is minimal delay in the initiation of effective ventilation in accordance to NRP guidelines. By not intubating and removal of meconium in the hypopharynx there is a chance of introducing additioanal meconium ino the tracheal and airways resulting in airway obstruction and inflammatory pneumonia and increased risk of airleaks. In the absence of high quality data regarding intubation and sucking it is inadvisable to may such a strong recommendation of not providing airway inspection and the option for suctioning. The absence of high quality data will continue until an appropriate RCT is conducting comparing one strategy versus the other. As meconium presence in the AF is a risk factor for poorer outcome, and is usually known prior to delivery there is ample opportunity to obtain consent from the mother for either option depending on randomization. The data presented do not give the number needed to harm if intubation is performed and meconium is suctioned in non-vigorous newly born infants. An appropriately powered RCT with appropriate outcomes is critical. Why make inappropriate recommendations when the data are lacking?