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
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 -
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
Would be interesting to study if bulb suctioning of oropharynx upon delivery of head (not entire body) made any difference. In past I found very few infants who responded by taking a breath during that process as the chest was compressed during labor, but made PPV easier as airway clearer. -
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
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. -
Виктория Антонова
Thank you for submitting an early recommendation for this important issue! I agree with the new /revised statement. As a pediatrician working at the bedside and present for deliveries, I agree there is a real potential for delay in vital PPV with multiple ETT intubation and suctioning attempts. I’ve worked under both systems and believe infants get more prompt airway / breathing assistance with the more direct path of offering PPV immediately. -
Виктория Антонова
I have been working with neonates for almost 40 years and I have found that infants that get intubated and their airway cleared do much better. I listen to what they sound like and the difficulty they have with breathing and make my decision on their stats. I understand that if you do not have someone that is good at intubation, it can waste valuable time. However, if you have capable staff for intubation, the infant recovers much faster and a lot of them do not need to have prolonged stays in a level II or III because of an effective resuscitation.