Search Our Scientific Publications & Authors

Neoreviews 2022 04;23(4):e250-e261

Division of Neonatology, Kaiser Permanente Moanalua Medical Center, Honolulu, HI.

Before 2015, major changes in Neonatal Resuscitation Program (NRP) recommendations not supporting previously endorsed antepartum, intrapartum and postpartum interventions to prevent meconium aspiration syndrome were based on adequately powered multicenter randomized controlled trials. The 2015 and 2020 American Heart Association guidelines and 7th and 8th edition of NRP suggest not performing routine intubation and tracheal suctioning of nonvigorous meconium-stained newborns. However, this was given as a weak recommendation with low-certainty evidence. Read More

Obstet Gynecol 2021 06;137(6):1109-1118

Department of Gynecologic Oncology and Reproductive Medicine, the Department of Health Services Research, Division of Cancer Prevention and Population Sciences, and the Department of Breast Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas; the Department of Obstetrics and Gynecology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts; the Department of Obstetrics and Gynecology, the University of Texas Medical Branch at Galveston, Galveston, Texas; and the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, and the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, New York.

Objective: To evaluate the outcomes of the first pregnancy after fertility-sparing surgery in patients treated for early-stage ovarian cancer.

Methods: We performed a retrospective study of women aged 18-45 years with a history of stage IA or IC ovarian cancer reported to the California Cancer Registry for the years 2000-2012. These data were linked to the 2000-2012 California Office of Statewide Health Planning and Development birth and discharge data sets to ascertain oncologic characteristics and obstetric outcomes. Read More

BMC Pregnancy Childbirth 2018 Oct 30;18(1):429. Epub 2018 Oct 30.

Department of midwifery, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia.

Background: Meconium stained amniotic fluid is one of the risk factors to increase the rate of perinatal morbidity and mortality both in developed and developing countries. Due to a multitude of factors associated with socioeconomic and quality of service, the ill effect of meconium stained amniotic fluid is even worse in developing countries. But very little information is known about the situation in Ethiopia, particularly the study area to design appropriate prevention strategies. Read More

JBI Database System Rev Implement Rep 2019 02;17(2):170-208

Department of Midwifery and Therapeutic Sciences, University College Copenhagen, Copenhagen, Denmark.

Objective: The objective of this review was to identify, assess and synthesize the best available evidence on the effects of induction prior to post-term on the mother and fetus. Maternal and fetal outcomes after routine labor induction in low-risk pregnancies at 41+0 to 41+6 gestational weeks (prior to post-term) were compared to routine labor induction at 42+0 to 42+6 gestational weeks (post-term).

Introduction: Induction of labor when a pregnancy exceeds 14 days past the estimated due date has long been used as an intervention to prevent adverse fetal and maternal outcomes. Read More

Adv Neonatal Care 2018 Aug;18(4):267-275

Division of Neonatology, Department of Pediatrics, University of Washington, Seattle.

Background: The approach to intrapartum and postnatal management of an infant born through meconium-stained amniotic fluid (MSAF) in the delivery room (DR) has changed several times over the last few decades, leading to confusion and anxiety among health care providers (nurses, nurse practitioners, respiratory therapists, midwives, and physicians). This article provides state-of-the-art insight into the evidence or lack thereof for the changes in guidelines.

Purpose: To discuss the evidence for evolution of DR management of vigorous and nonvigorous infants born through any type of MSAF. Read More

Obstet Gynecol 2017 03;129(3):e33-e34

In 2006, the American Academy of Pediatrics and the American Heart Association published the 2005 guidelines on neonatal resuscitation. Before the 2005 guidelines, management of a newborn with meconium-stained amniotic fluid included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders. The 2005 guidelines did not support this practice because routine intrapartum suctioning does not prevent or alter the course of meconium aspiration syndrome in vigorous newborns. Read More

Obstet Gynecol 2017 03;129(3):593-594

In 2006, the American Academy of Pediatrics and the American Heart Association published the 2005 guidelines on neonatal resuscitation. Before the 2005 guidelines, management of a newborn with meconium-stained amniotic fluid included suctioning of the oropharynx and nasopharynx on the perineum after the delivery of the head but before the delivery of the shoulders. The 2005 guidelines did not support this practice because routine intrapartum suctioning does not prevent or alter the course of meconium aspiration syndrome in vigorous newborns. Read More

Pediatr Rev 2014 Oct;35(10):417-28; quiz 429

Department of Neonatal-Perinatal Medicine, Sanford School of Medicine-University of South Dakota, Sanford Children's Specialty Clinic, Sioux Falls, SD. Sanford Children's Health Research Center, Sioux Falls, SD.

Respiratory distress presents as tachypnea, nasal flaring, retractions, and grunting and may progress to respiratory failure if not readily recognized and managed. Causes of respiratory distress vary and may not lie within the lung. A thorough history, physical examination, and radiographic and laboratory findings will aid in the differential diagnosis. Read More

Eur J Pediatr 2015 Feb 3;174(2):237-43. Epub 2014 Aug 3.

Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India,

Unlabelled: The objective of the study was to evaluate the effect of administering prophylactic antibiotics on the development of neonatal sepsis in term neonates born through meconium-stained amniotic fluid (MSAF). Two hundred and fifty eligible neonates were randomized to study group (Antibiotic group-receiving first-line antibiotics for 3 days) and control group (No Antibiotic group). Both groups were evaluated clinically and by laboratory parameters (sepsis screen and blood cultures) for development of sepsis. Read More

Arch Cardiol Mex 2014 Apr-Jun;84(2):121-7. Epub 2014 May 3.

Área de Investigación en Pediatría, Unidad Neonatal, Fundación Cardiovascular de Colombia, Floridablanca, Colombia.

Extracorporeal membrane oxygenation is considered a rescue therapy and complex vital support with benefits in cardiorespiratory diseases during neonatal period that fulfil the characteristics of being reversible in neonates older than 34 weeks. The criteria for patient selection and its prompt use are critical for the final result. Even though new alternatives for management of hypoxemic respiratory failure in full term and almost full term neonates have decreased its use, congenital diaphragmatic hernia continues being a complex disease where it can have some applicability. Read More

J Obstet Gynaecol Res 2013 May 17;39(5):953-9. Epub 2013 Mar 17.

Department of Obstetrics and Gynecology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Aim: To study the nature and clinical outcome of pregnancies with obstetric cholestasis on active management and to correlate perinatal outcome to gestational age at delivery.

Material And Methods: This prospective randomized study included 69 women with obstetric cholestasis. Fetal surveillance began at 34 weeks or later at diagnosis and included daily maternal record of fetal movements, and biophysical profile (i. Read More

Ginekol Pol 2012 Sep;83(9):713-7

Katedra i Klinika Połoznictwa i Perinatologii, Uniwersytet Medyczny w Lublinie.

Intrahepatic Cholestasis of Pregnancy (ICP) constitutes the most common, reversible liver disease closely connected with pregnancy and spontaneously resolving in puerperium. ICP usually reoccurs in consecutive pregnancies (45-90%), often in a more intensified form. Many compounds (hormones, cytokines, medicines, endotoxins) can impair transport in the hepatocyte, disturb the intracellular transport and increase the permeability of the intercellular connections. Read More

Sudan J Paediatr 2013 ;13(1):11-22

Department of Pediatrics , College of Medicine, King Saud University, Riyadh , Saudi Arabia.

The efficacy of surfactant preparations used in the prevention and treatment of respiratory distress syndrome (RDS) is a well known fact; however, many controversies remain. The debate over which surfactant to be used, when and what is the best mode of delivery is still raging. Currently, animal-derived surfactants are preferred and clearly recommended by various practice guidelines, but new synthetic surfactants containing peptides that mimic the action of surfactant proteins are emerging and they seem to have a comparable efficacy profile to the natural surfactants. Read More

Clin Perinatol 2012 Dec;39(4):817-31

Department of Pediatrics, Children`s Hospital of Wisconsin, Medical College of Wisconsin, Room 410, CCC, 999 North 92 Street, Wauwatosa, WI 53226, USA.

This article discusses the historical background, epidemiology, and pathophysiology of meconium-stained amniotic fluid and provides current concepts in delivery room management of meconium-stained neonate including the current Neonatal Resuscitation Program guidelines. Read More

Niger J Clin Pract 2012 Jul-Sep;15(3):354-7

Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

Background/aim: Intestinal atresia is a common cause of neonatal intestinal obstruction. Jejuno-ileum is the commonest site of intestinal atresia. Reports on Jejunoileal atresia in developing countries are still few. Read More

Int J Pediatr 2012 22;2012:359571. Epub 2011 Nov 22.

Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada T2N 1N4.

Meconium aspiration syndrome (MAS) is a common cause of severe respiratory distress in term infants, with an associated highly variable morbidity and mortality. MAS results from aspiration of meconium during intrauterine gasping or during the first few breaths. The pathophysiology of MAS is multifactorial and includes acute airway obstruction, surfactant dysfunction or inactivation, chemical pneumonitis with release of vasoconstrictive and inflammatory mediators, and persistent pulmonary hypertension of newborn (PPHN). Read More

Early Hum Dev 2011 Mar 31;87 Suppl 1:S13-5. Epub 2011 Jan 31.

FUNDASAMIN (Fundación para la Salud Materno Infantil), Buenos Aires, Argentina.

Meconium aspiration syndrome (MAS) is a life threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Its obstetric and perinatal management has been changing for over 35 years. In pregnancies complicated by MSAF, suction of the hypopharynx before the delivery of the infant's shoulders and postnatal suction of vigorous infants have been used in an effort to clear the airway and decrease the incidence and the severity of the disease. Read More

Minerva Pediatr 2010 Jun;62(3 Suppl 1):165-7

Terapia Intensiva Pediatrica e Neonatale, Azienda Ospedaliera-Universitaria Integrata, Verona, Italy.

In the neonatal population, pleural effusion and particularly tension pneumothorax can be a deadly situation. Pneumothorax occurs more often in the neonatal period that any other time of life. Tension pneumothorax can result in very high pressures within the pleural space, collapsing the lung on the involved side and resulting in immediate hypoxia, hypercapnia and subsequent circulatory collapse. Read More

Trop Doct 2010 Jan 22;40(1):33. Epub 2009 Oct 22.

Fiji School of Medicine, Department of Paediatrics, Lautoka Hospital, PO Box 65, Lautoka, Fiji.

Severe meconium aspiration syndrome is difficult to manage and has a high mortality in developing countries. Guidelines are available for the initial management. If the infant has been born through particulate meconium and is not vigorous, an inspection of the vocal cords by laryngoscopy is recommended. Read More

Early Hum Dev 2009 Oct 14;85(10):621-6. Epub 2009 Oct 14.

Hospital Sanatorio Trinidad, University of Buenos Aires, Chenaut 1831, Buenos Aires, 1426, Argentina.

Meconium aspiration syndrome (MAS) is a life-threatening disorder in newborn infants. Universal intrapartum suction of infants with meconium stained amniotic fluid (MSAF) and postnatal suction of vigorous infants have been used in an attempt to decrease the incidence and severity of the disease by clearing the airway. Both procedures have been proven fruitless when challenged through randomised control trials (RCTs). Read More

Am J Perinatol 2010 Apr 5;27(4):271-8. Epub 2009 Oct 5.

Department of Obstetrics and Gynecology, Université de Montréal/Hôpital Sainte-Justine, Montreal, Quebec, Canada.

We sought (1) to identify risk factors for meconium aspiration syndrome (MAS) among infants born to women whose labors were complicated by thick-consistency meconium-stained amniotic fluid (MSAF), and (2) to determine whether risk factors and infant prognosis differ according to the time of onset of respiratory distress. We performed a secondary analysis of a multicenter randomized trial of amnioinfusion (AI) for the prevention of MAS among women with thick-consistency MSAF. MAS was defined as onset of respiratory distress requiring oxygen supplementation within the first 4 hours of life. Read More

Int J Gynaecol Obstet 2009 Oct;107(1):80-1

Objective: To provide clinician direction that is based on the best evidence available on suctioning at the perineum for infants born with meconium stained amniotic fluid.

Evidence: The Medline database was searched for articles published in English from 2000 to 2008 on the topic of management of meconium at birth.

Values: The recommendation was made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Read More

BJOG 2009 Jun;116(7):923-32

TNO Quality of Life, Netherlands Organisation for Applied Scientific Research TNO, Leiden, the Netherlands.

Objective: To assess the trends and patterns of referral from midwives to obstetricians within the Dutch maternity care system from 1988 to 2004, and the differences in referral patterns between nulliparous and parous women.

Design: A descriptive study.

Setting: The Dutch midwifery database (LVR1), which monitored 74% (1988) to 94% (2004) of all midwifery care in the Netherlands between 1988 and 2004. Read More

J Obstet Gynaecol Can 2009 Apr;31(4):353-354

Toronto ON.

Objective: To provide clinician direction that is based on the best evidence available on suctioning at the perineum for infants born with meconium stained amniotic fluid.

Evidence: The Medline database was searched for articles published in English from 2000 to 2008 on the topic of management of meconium at birth.

Values: The recommendation was made according to guidelines developed by the Canadian Task Force on Preventive Health Care. Read More

Proc (Bayl Univ Med Cent) 2009 Apr;22(2):128-31

Department of Pediatrics and Neonatology, Baylor University Medical Center, Dallas, Texas, USA.

The approach to preventing meconium aspiration syndrome (MAS) in the newborn has changed markedly over the last 30 years. In the late 1970s, all infants born through meconium-stained amniotic fluid (MSAf) had upper-airway suctioning before delivery of the shoulders and then had tracheal intubation and suctioning in the delivery room. Now suctioning of the upper airway is no longer recommended, and only "depressed" infants are intubated for tracheal suctioning. Read More

J Perinatol 2008 Dec;28 Suppl 3:S30-5

Division of Neonatal and Developmental Medicine, Department of Pediatrics, Lucile Salter Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA.

Passage of fetal bowel movement (meconium) is common (in about one out of six births), and in some the staining of the amniotic fluid is a sign of fetal distress. Inhalation of meconium (aspiration syndrome, in upto one out of five to eight such births) just before or at birth may be preventable by a coordinated approach by well-trained and informed birth attendants. Respiratory failure secondary to meconium aspiration syndrome (MAS) remains a major cause of morbidity and mortality in the neonatal population. Read More

J Perinatol 2008 Dec;28 Suppl 3:S3-7

Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children's Hospital/University Hospitals Case Medical Center, Cleveland, OH 44106, USA.

The meconium aspiration syndrome (MAS) is a common problem that continues to concern perinatologists and neonatologists. MAS is defined as respiratory distress in an infant born through meconium-stained amniotic fluid (MSAF) whose symptoms cannot be otherwise explained. This disorder may be life threatening, complicated by respiratory failure, pulmonary air leaks and persistent pulmonary hypertension. Read More

J Perinatol 2008 Dec;28 Suppl 3:S19-26

Center for Neonatal Care, Orlando, FL 32804, USA.

Review of all medical literature dealing with delivery room management of meconium-stained infants. Additionally, the author contacted multiple individuals involved historically or clinically with the published studies or the persons who developed treatment guidelines. Although many therapies have been suggested as being effective, none have been definitively proven efficacious by the gold standard: a large, randomized, controlled trial (RCT). Read More

J Perinatol 2008 Dec;28 Suppl 3:S14-8

Department of Obstetrics and Gynecology, Hôpital Sainte-Justine, Université de Montréal, Montreal, QC, Canada.

Meconium aspiration syndrome (MAS) is associated with increased risk for perinatal mortality and morbidities. To provide an overview of the advances in our knowledge concerning the obstetric approaches to the prevention of MAS. The evidence of the effectiveness of intrapartum surveillance, amnioinfusion, and delivery room management in the prevention of MAS are reviewed in the present paper. Read More

Neonatal Netw 2008 Mar-Apr;27(2):81-7

Level III NICU, Banner Children's Hospital, Mesa, Arizona, USA.

Meconium aspiration syndrome (MAS) is one of the most common conditions associated with aspiration during the newborn period. MAS can be defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAE) with symptoms that cannot otherwise be explained. It can be characterized by early onset of respiratory distress in term and near-term infants delivered through MSAE. Read More