Dear All, we have great controversies in openion regarding; is that necessary for neonatologist to attend all meconium stained liqour deliveries ? knowing that these deliveries are normal without any evidence of fetal distress, not IUGR, normal CTG and fetal HR .

please i need your feedback with evidence if possible .

best regards

Dr. Alaa

specialist neonatology

UAE

In one hospital where I worked in the yearly 2000s, the dr on call was always asked to attend such deliveries. To perform upper airway suctioning when the head was out... this was before the publication of the RCT that showed no benefit of such an aggressive strategy (http://www.ncbi.nlm.nih.gov/pubmed/15313360) - but still...!

I think I can speak for all hospitals in Stockholm: the neonatologist/resident on call is not attending deliveries when there is no sign of fetal distress.

I think the answer will depend on the competency of the 'baby' nurse in the delivery room in neonatal resuscitation. If the 'baby nurse' (the nurse handling the baby in the delivery room) is competent to initiate neonatal resuscitation in case of a depressed baby, then the doctor may not be needed. However if the 'baby nurse' is not trained in neonatal resuscitation then it may be risky.

Hi, working as a neonatal registrar in Melbourne (level 3) we are asked to attend all deliveries w mec stained liquor, even if everything else reg labour and pregnancy is normal. As Dr Johansson writes above, I'm not used to this strategy in Stockholm.

Regards,

B. Skiold

MD, PhD

Karolinska Stockholm and RWH Melbourne

this is still a grey area in NRP, even in the 6th edition. The evidence does not show that tracheal suctioning in mec-stained amniotic fluid babies prevent mec aspiration, but

"Absence of evidence does not equal evidence of absence". We know that most mec aspiration occurs in utero, and only small percentage can occur shorty after birth, and tracheal suctioning does not prevent the aspiration that has already occur, but may it could prevent a small percentage of aspration that can occur after birth, or at least eliminate the blocking mec articles sitting in the airway from in-utero aspiration, so that ventilation is achieve easier

Based on this assumptions, I agree with Dr. Stefan that not all babies born through mec-stained amniotic fluid need tracheal suctioning (and a neonatologist present) just the ones that may have aspirated in-utero due to gasping breaths (Those with NRFHTs). The

competence of the labor and delivery responder should of course be a factor, but this is a standard NRP recc that one person able to initiate NRP (Able to stim, warm, suction and bag if needed) should be present at every delivery, this allow the Neos to be available within a reasonable time to respond if the infant needs intubation.

In our institution we have stablished:

1. Vigorous babies born through mec, regular NRP is provided

2. Depressed infants born through light mec, regular NRP, if apnea persists ppv is provided

3. Depressed infants born through thick mec with no h/o NRFHTs, (likely terminal mec),

regular NRP plus oropharyngeal suctioning, and ppv if apnea persists

4. Depressed infants born through mec with h/o NRFHTs, tracheal suctioning followed by regular NRP, ppv if bradycardia develops.

hi there,neerly one third of meconioum stained liquer born babies will need active resucitations, so yes indeed a pediatrician must attend all mec stained babies, this is feasable to prevent huge complications,,i agree with tactics in abeuchin reply anyhow coloured amniotic fluid is a cry for helppppp.

Thanks to all of you for the useful feed back. In my openion , as most of you mentioned earlier mec. Aspiration is mainly in utero problem and it's actually an obstetric rather than neonatal emergency. So prevention of aspiration is an obstetric job in first place and neonatologist prevents further complications. I think if there is meconium st. Liquor with maternal risk factors such as evidence of infection, placental insufficiency, IUGR, fetal distress, maternal sedation a neonatologist should attend delivery . If no such risks i guess a person trained in neonatal resuscitation is enough . In my practice all babies so far delivered with mec. St. Liqour and no risk factor were fune at birth. Thanks again for feed back