Recent discussions
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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 . -
Виктория Антонова
Since the NRP statement was publicized I have been concerned about the absolute interpretations of the wording “ROUTINE suctioning is no longer RECOMMENDED” in the depressed infant born through MSAF. In our institution it was taken as an absolute, that no baby should EVER be suctioned below the cords and those of us with many decades of experience who are expert intubators were rebuked harshly for doing so. I am very concerned that the statement has been taken too literally and that it should be reworded in such a way as to give an experienced provider the option without subsequent scorn. -
Виктория Антонова
Agree with the evidence based recommendations as above. My only comment is as follows. Suctioning out the gastric fluid after resuscitation in depressed infants born through meconium stained amniotic fluid should be considered as the gastric contents may be meconium stained and get aspirated into the lungs espy in non intubated babies . The possibility may not be high and there is not much literature on it but this potentially is a clinical set up worth considering or looking into in future studies. -
Виктория Антонова
Since the NRP statement was publicized I have been concerned about the absolute interpretations of the wording “ROUTINE suctioning is no longer RECOMMENDED” in the depressed infant born through MSAF. In our institution it was taken as an absolute, that no baby should EVER be suctioned below the cords and those of us with many decades of experience who are expert intubators were rebuked harshly for doing so. I am very concerned that the statement has been taken too literally and that it should be reworded in such a way as to give an experienced provider the option without subsequent scorn. -
Виктория Антонова
The data to not suction are weak. I have observed and reviewed several deliveries with non-vigorous meconium stained babies. I have found suctioning to be helpful in the delivery room. SInce the new standards were in place, I have witnessed more issues after birth in the NICU. I think the motive to eliminate this step (suctioning) was more to protect hospitals for not having trained providers in the delivery room in cases of meconium stained fluid. Better to educate and train than keep dumbing down the standards. PLEASE AAP stop diluting the standards to appeal to the least common denominator. Having practiced neonatology for decades, I notice this is happening. Hold the line please. -
Виктория Антонова
I agree with the findings of the review -
Виктория Антонова
If the ET suction is quick and efficient with no loss of HR. Then it should be done. If this cannot be guaranteed, and it most likely cannot, then resuscitation should start immediately. -
Виктория Антонова
I would like to see outcomes relating to intubation stratified by "experience." I was trained in an era when all meconium stained infants (rightly or wrongly....mostly wrongly) were intubated. I wonder if, for those neonatologists that are still ACTIVELY practicing CLINICAL medicine, if their time to successful intubation and their percentage of successful first time attempts are higher than more junior practitioners that were trained in an era of decreased intervention (read - have had much less reps with intubation). That said, I wonder if ILCOR should look into these demographics and consider language that takes this into account (if the data supports that currently clinical active practitioners whose training occurred in the "intubate all meconium infants" are more adept at intubating than those practitioners who were trained in the "post- Wisell" era. -
Виктория Антонова
After 40 years of neonatal nursing I knew this recommendation for "no tracheal suctioning" was not a good recommendation. I have always thought at least one suction pass was best and then intubation if necessary for time restraints. But NO suctioning was a bad idea for non-vigorous infants with thick meconium. I would like to see the recommendation be for one tracheal suction pass, and then intubation if needed. Several passes will delay intubation and possibly not clear the airway that much better, and no suctioning is not a good practice. -
Виктория Антонова
Thank you for doing this work. "Very low certainty evidence" exceeds the value of the anecdotes that resulted in the practice of immediate tracheal suctioning in the first place. Immediate tracheal suctioning delays the resuscitation of these non-vigorous infants at a time when every second counts.