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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

Arch Pediatr 2007 Nov 10;14(11):1389-93. Epub 2007 Oct 10.

Smur pédiatrique des Hauts de Seine (Samu 92) et service de pédiatrie et de réanimation néonatales, hôpital Antoine-Béclère (APHP), 157, rue de la Porte-de-Trivaux; 92141 Clamart cedex, France.

Since a decade, some studies had discussed preventive and curative treatment of infants born to mothers with meconium-stained amniotic fluid. Today amnio-infusion, formerly proposed, is reconsidered in countries where midwives and obstetricians carefully monitor the fetal heart rate tracing during labor. Actually routine intrapartum oropharyngeal and nasopharyngeal suctioning, before and after shoulders delivery, followed by tracheal suction, are not recommended for infants born to mothers with meconium stained amniotic fluid. Read More

Obstet Gynecol 2007 Sep;110(3):739

In accordance with the new guidelines from the American Academy of Pediatrics and the American Heart Association, all infants with meconium-stained amniotic fluid should no longer routinely receive intrapartum suctioning. If meconium is present and the newborn is depressed, the clinician should intubate the trachea and suction meconium and other aspirated material from beneath the glottis. Read More

Ann Trop Paediatr 2007 Jun;27(2):107-13

Division of Neonatology, Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Background: Meconium aspiration syndrome (MAS) is a major cause of severe respiratory distress in newborns and the role of antibiotics in its management is not well defined.

Objective: To determine the role of routine antibiotic therapy in the management of MAS.

Methods: After excluding the possibility of sepsis, 144 patients with MAS were randomised into two groups. Read More

J Gynecol Obstet Biol Reprod (Paris) 2007 Nov 29;36(7):663-70. Epub 2007 May 29.

Département de gynécologie obstétrique du centre hospitalier du Havre, Le Havre, France.

The aim of this review was to revisit the evaluation of risk of foetal and neonatal mortality at term. We analyse the meaning of term period and difficulty to determine the normal duration of the pregnancy. Specific complications associated with post term and the statistic approach of the perinatal risk are analysed, together with various mortality rates and especially the prospective risk introducing foetal term as a new concept. Read More

J Trop Pediatr 2007 Oct 29;53(5):331-7. Epub 2007 May 29.

Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.

Background: Meconium aspiration syndrome (MAS) is one of the major causes of severe respiratory distress in the newborn and there is no uniform protocol of management after the development of MAS.

Objective: The objective of the study was to determine whether systemic and inhalational steroid therapy can alter the clinical course of MAS and improve the outcome without causing any serious adverse effects.

Methods: A randomized controlled trial was conducted in three groups of MAS over a period of 1 year. Read More

Arch Pediatr 2007 Feb 16;14(2):150-6. Epub 2006 Oct 16.

Service de réanimation pédiatrique et néonatologie, hôpital Clocheville, 49, boulevard Béranger, 37000 Tours, France.

Unlabelled: The meconium aspiration syndrome is the first cause of respiratory distress in full term newborns. At birth, management includes systematical oropharyngeal suctioning, before and after shoulders delivery, followed by tracheal suction. During last 10 years, many trials were published which discuss again the value of this strategy. Read More

Obstet Gynecol 2006 Sep;108(3 Pt 1):635-43

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco General Hospital, San Francisco, California 94110, USA.

Objective: To examine the relationship between gestational weight gain and adverse neonatal outcomes among infants born at term (37 weeks or more).

Methods: This was a retrospective cohort study of 20,465 nondiabetic, term, singleton births. We performed univariable and multivariable analyses of the associations between gestational weight gain and neonatal outcomes. Read More

Zhonghua Fu Chan Ke Za Zhi 2006 Jun;41(6):391-4

Department of Obstetrics, Maternal and Children's Health Hospital of Shanxi Province, Xi'an 710003, China.

Objective: To investigate the effect of infusion of sodium bicarbonate in amniotic cavity and exchange of amniotic fluid for fetus with distress and acidosis.

Methods: The patients included 40 cases of oligohydramnios with mild and serious abnormality of fetal heart rate and amniotic fluid contamination of degree II or more during the labor. The 40 cases had exchange of amniotic fluid with infusion under continuous monitoring. Read More

Clin Perinatol 2006 Mar;33(1):29-42, v-vi

Department of Paediatrics, University of the Witwatersrand, Edenglen Edenvale, 1609 Johannesburg, South Africa.

The article reviews and critically evaluates the available evidence to determine whether the current recommendations for the management of infants born through meconium stained amniotic fluid (MSAF) should be maintained. Authors provide evidence-based recommendations regarding the benefits of amnioinfusion prior to delivery, oral suctioning of the newborn prior to delivery of the shoulder, and the practice of routine endotracheal suctioning of the newborn born through MSAF in preventing meconium aspiration syndrome (MAS). Authors also discuss the gaps in knowledge in all the above interventions to prevent MAS. Read More

Eur J Pediatr 2005 Dec 1;164(12):789; author reply 790. Epub 2005 Oct 1.

J Perinatol 2005 Nov;25(11):694-7

Department of Pediatrics, Division of Neonatology, Connecticut Children's Medical Center, Hartford, CT, USA.

Objective: To study the impact of neonatal resuscitation program (NRP) guidelines on delivery room (DR) management of infants born through meconium-stained amniotic fluid (MSAF).

Study Design: A retrospective study of all term (>or=37 weeks) infants born through MSAF was performed. Patients were divided into two periods: pre year 2000 NRP and post year 2000 NRP. Read More

Semin Perinatol 2005 Feb;29(1):24-33

Pediatric Intensive Care Unit, Children's National Medical Center, 111 Michigan Ave NW, Suite 100, 3 W, Washington, DC 20010, USA.

Since its beginnings in 1989, the Extracorporeal Life Support Organization (ELSO) Registry has collated and reported data on over 30,000 patients. The majority of patients entered into the Registry have been neonates with respiratory failure from meconium aspiration, persistent pulmonary hypertension, or congenital diaphragmatic hernia. These patients suffer from refractory hypoxemia; thus, this supportive technique came to be called "Extracorporeal Membrane Oxygenation (ECMO)" for its ability to provide excellent gas exchange. Read More

Eur J Pediatr 2005 May 25;164(5):329-30. Epub 2005 Feb 25.

Division of Asthma, Allergy and Lung Biology, Department of Child Health, 4th Floor Golden Jubilee Wing, King's College Hospital, Denmark Hill, SE5 9RS London, UK .

Indian J Pediatr 2004 Aug;71(8):677-81

Department of Obstetrics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India.

Objective: There are conflicting reports regarding the results of amnioinfusion in the management of meconium passage in utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.

Methods: 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Read More

Lancet 2004 Aug 14-20;364(9434):597-602

Sanatorio de la Trinidad Hospitals, Buenos Aires, Argentina.

Background: Meconium aspiration syndrome (MAS) is a life-threatening respiratory disorder in infants born through meconium-stained amniotic fluid (MSAF). Although anecdotal data concerning the efficacy of intrapartum oropharyngeal and nasopharyngeal suctioning of MSAF are conflicting, the procedure is widely used. We aimed to assess the effectiveness of intrapartum suctioning for the prevention of MAS. Read More

Arch Pediatr 2004 May;11(5):417-22

Service de réanimation néonatale et pédiatrique, hôpital d'enfants Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75571 Paris 12, France.

Objectives: To precise the number of term neonates with a meconium aspiration syndrome requiring mechanical ventilation in 2000 and 2001 in continental France and the related mortality. To study the different respiratory management.

Method: A written questionnaire was sent to all intensive care units of continental France. Read More

Ann Acad Med Singapore 2003 May;32(3):335-45

Department of Pediatrics, Neonatal Division, Given Building, University of Vermont College of Medicine, Burlington, VT 05405, USA.

Exogenous surfactant therapy has an established role in the management of neonatal respiratory distress syndrome (RDS). This article summarises the current evidence on surfactant therapy. The use of surfactant for the treatment or prophylaxis of neonatal RDS results in a 30% to 65% relative reduction in the risk of pneumothorax and up to a 40% relative reduction in the risk of mortality. Read More

Birth 2002 Jun;29(2):137-40

Division of Maternal-Fetal Medicine, University of Rochester School of Medicine, New York 14642, USA.

Zhonghua Fu Chan Ke Za Zhi 2000 Jan;35(1):20-2

Department of Obstetrics, Maternal and Children Health Hospital of Shanxi province, Xi'an 710003, China.

Objective: To discuss the significance of amnioinfusion and amniotic fluid exchange under continuous internal fetal heart rate (FHR) monitoring for management of fetal distress during labor.

Methods: 136 cases with frequent variable deceleration (VD) and meconium stained amniotic fluid during labor were divided into two groups: the study group (68 cases) and the control group (68 cases). The former were treated by amnioinfusion and amniotic fluid exchange, while oxygen inhalation, change of body position, and intravenous infusion for the control group. Read More

J Perinat Med 2001 ;29(6):465-8

Neonatology Unit, University of Messina, Messina, Italy.

The delivery room management of infants born through meconium stained amniotic fluid (MSAF) remains controversial. The aim of this prospective study was to evaluate maternal and neonatal characteristics of MSAF infants and the incidence of meconium aspiration syndrome (MAS) in routine delivery room management which reserved selective intubation for depressed/asphyxiated babies. Between October 1993 and September 1997, a consecutive sample of 3745 full-term infants was analyzed. Read More

Australas J Dermatol 2001 Aug;42(3):207-10

Flinders Medical Centre, Bedford Park, South Australia, Australia.

A female infant was delivered at term with complications of severe meconium aspiration and birth asphyxia. Surface cooling was performed in the first 24 hours as part of the management of her birth asphyxia. Woody erythema was noted at 24 hours, followed by the formation of red-purple nodules on the 6th day. Read More

Cochrane Database Syst Rev 2001 (1):CD000500

Department of Child Health, Queen's University of Belfast, Regional Neonatal Unit, Royal Maternity Hospital, Belfast, Northern Ireland, UK, BT12 6BB.

Background: On the basis of evidence from non-randomised studies, it has been recommended that all babies born through thick meconium should have their tracheas intubated so that suctioning of their airways can be performed. The aim is to reduce the incidence and severity of meconium aspiration syndrome. However, for term babies who are vigorous at birth endotracheal intubation may be both difficult and unnecessary. Read More

Eur J Cardiothorac Surg 2000 Sep;18(3):328-33

Department of Thoracic Surgery, A. Calmette Hospital, Centre Hospitalier Régional et Universitaire de Lille, Bd. du Professeur Leclercq, 59037 cedex, Lille, France.

Objective: Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit.

Methods: Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Read More

Pediatrics 2000 Sep;106(3):E29

The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: * Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. Read More