From the Guidelines
No, routine suctioning of newborns with thick meconium is no longer recommended. Current guidelines advise against both oropharyngeal suctioning before delivery of the shoulders and routine direct laryngoscopy with endotracheal suctioning for vigorous newborns, even in the presence of thick meconium, as stated in the 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations 1. Instead, the focus should be on standard resuscitation measures including:
- warmth
- positioning
- clearing the airway as needed with a bulb syringe or suction catheter
- drying
- stimulation
For non-vigorous newborns with meconium (those with poor muscle tone, respiratory effort, or heart rate less than 100 beats per minute), immediate resuscitation should be prioritized rather than delaying for suctioning procedures. This change in practice is based on evidence showing that routine suctioning does not reduce the incidence of meconium aspiration syndrome or improve outcomes, while potentially causing harm by delaying resuscitation efforts and potentially causing vagal stimulation, laryngospasm, or trauma to delicate tissues 1. The current approach recognizes that most meconium aspiration occurs in utero, not during delivery, making post-delivery suctioning less effective at preventing complications. It is possible that the infant born through meconium-stained fluid will require intubation for resuscitation, and trained personnel and equipment for intubation should be readily available for births where meconium-stained amniotic fluid is present 1.
The previous guideline from 2015 also supported this approach, concluding that there is insufficient published evidence to support routine tracheal intubation for suctioning of meconium in even nonvigorous infants born through meconium-stained amniotic fluid, because it likely delays ventilation 1. However, the most recent and highest quality study from 2020 should be prioritized, which confirms that routine suctioning of newborns with thick meconium is no longer recommended 1.
From the Research
Current Practices in Suctioning Newborns with Thick Meconium
- The current guidelines no longer support routine intrapartum suctioning of newborns with meconium-stained amniotic fluid, whether they are vigorous or not 2.
- According to the 2015 updated guidelines, infants with meconium-stained amniotic fluid should no longer routinely receive intrapartum suctioning 2.
- However, in cases where the infant is non-vigorous, endotracheal suctioning may be performed 2, 3.
Management of Meconium Aspiration Syndrome
- Meconium aspiration syndrome (MAS) is a complex respiratory disease that requires supportive therapy tailored to each infant's specific pathophysiology 4, 5.
- Supplemental oxygen is the mainstay of therapy for MAS, with around one-third of infants requiring intubation and mechanical ventilation 4.
- High-frequency ventilation, inhaled nitric oxide, and other adjunctive therapies may be considered in selected cases 4, 6.
Delivery Room Management
- The immediate delivery room management of non-vigorous infants with meconium-stained amniotic fluid is controversial, with some studies suggesting that routine direct laryngoscopy with or without tracheal suctioning may not be necessary 3.
- However, other studies suggest that endotracheal suctioning may be beneficial in targeted non-vigorous infants 3.
- Fetal heart rate abnormalities and the presence of thick meconium are associated with an increased risk of meconium aspiration syndrome and serious pulmonary morbidity 3.