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In the absence of randomized, controlled trials, there is insufficient evidence to recommend a change in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid (Class IIb, LOE C).

Historically a variety of techniques have been recommended to reduce the incidence of MAS.

Suctioning of the oropharynx before delivery of the shoulders was considered routine until a randomized controlled trial demonstrated it to be of no value.

Once positive pressure ventilation or supplementary oxygen administration is begun, assessment should consist of simultaneous evaluation of 3 vital characteristics: heart rate, respirations, and the state of oxygenation, the latter optimally determined by a pulse oximeter as discussed under “Assessment of Oxygen Need and Administration of Oxygen” below.

The most sensitive indicator of a successful response to each step is an increase in heart rate.

Therefore it is recommended that suctioning immediately following birth (including suctioning with a bulb syringe) should be reserved for babies who have obvious obstruction to spontaneous breathing or who require positive-pressure ventilation (PPV) (Class IIb, LOE C).

Aspiration of meconium before delivery, during birth, or during resuscitation can cause severe meconium aspiration syndrome (MAS).Anticipation, adequate preparation, accurate evaluation, and prompt initiation of support are critical for successful neonatal resuscitation.At every delivery there should be at least 1 person whose primary responsibility is the newly born.Infants born to febrile mothers have been reported to have a higher incidence of perinatal respiratory depression, neonatal seizures, and cerebral palsy and an increased risk of mortality.and that suctioning of the trachea in intubated babies receiving mechanical ventilation in the neonatal intensive care unit (NICU) can be associated with deterioration of pulmonary compliance and oxygenation and reduction in cerebral blood flow velocity when performed routinely (ie, in the absence of obvious nasal or oral secretions).Several studies have demonstrated that a cesarean section performed under regional anesthesia at 37 to 39 weeks, without antenatally identified risk factors, versus a similar vaginal delivery performed at term, does not increase the risk of the baby requiring endotracheal intubation.

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