Recent discussions
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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? -
Виктория Антонова
Back in 2000, when I started as a pediatric resident, I asked my senior resident why we intubated for meconium, since it seems to go against the fundamental principle of NRP, which is to avoid secondary apnea. He told me the only reason we do it is because we need the practice (even though that was the guideline at the time). It seems that this is one of those medical practices that someone thought up that then people continue to hold onto. I realize the evidence isn't great, but I am not sure why we need to continue to explore this question further. Glad to see that the task force did take on the job of reviewing the new articles for me and reaffirming their statement. -
Виктория Антонова
We have not had any cases of MAS after we stopped suctioning vigorous infants with hx of meconium . Our mec babies were Tx with BCPAP if needed, and recovered well. -
Виктория Антонова
This is comprehensively written and the identification of areas of needed research is extremely valuable in highlighting the real gaps -
Lloyd Jensen
Thanks for going through the process . It can be very difficult. -
Виктория Антонова
Although we acknowledge the lack of evidence, by coming up with recommendations which are not strongly worded opens the door to continue nebulous practice and as such inability for us to truly understand the impact of these recommendations in the clinical practice situation -
Виктория Антонова
I agree as an RN and NPR instructor in a smaller hospital where intubation is not always immediately available. -
Виктория Антонова
I am disappointed that this protocol will remain unchanged. Although I do not have a study to back up my thoughts, I have been a NICU Nurse for 36 years, and a NRP Instructor for 30 of those years. I have seen many babies saved the prolonged and difficult healing process from MAS because they received direct visualization and suctioning, after being born through particulate meconium and are non-vigorous with HR <100 (or absent). When particulate meconium, which is in the airway, is blown into the chest with PP ventilation, healing is much more difficult. We have an experienced incubator at every MSAF delivery. We never intunate/suction vigorous infants. I continue to advocate for direct visulization/ suction of the sickest MSAF infants.