PURPOSE: To explore the degree of variation in routine management of infants born through meconium-stained amniotic fluid (MSAF) in New Hampshire. METHODS: In spring 1994 a survey was sent to one pediatrician or family practitioner (FP), one obstetrician, and one labor nurse manager at each of the 26 hospitals in the state providing delivery services. Questions dealt with usual practices regarding attendance at these deliveries by pediatricians/FPs, routine intubation and tracheal suction, major influences on practice, and Neonatal Resuscitation Program (NRP) certification. Responses were received from 20 obstetricians, 23 pediatricians/FPs, and 26 nurse managers; overall response rate was 90% including at least one response from each hospital. RESULTS: Ten percent of respondents stated that no deliveries were attended routinely by a pediatrician or FP, while 7% said that no infants were intubated routinely. Many practitioners do not routinely provide tracheal suction for depressed infants born through thin meconium, or for vigorous infants with thick MSAF (TABLE). Several different sources were cited as the most important influence on practice: NRP (46%). AAP/ACOG Perinatal Guidelines (11%), local experience (11%), and the medical literature (7%) were most frequent. While 97% of nurses, 65% of obstetricians, and 71% of pediatricians/FPs were NRP certified, hospitals with higher rates of physician NRP certification did not have different practices regarding airway management or attendance at deliveries when compared with those with lower rates. CONCLUSION: Management of infants born through MSAF is not uniform among the hospitals surveyed. Variations in practice are particularly common with depressed infants born through thin meconium, or for vigorous infants with thickly stained fluid. We speculate that this may be due to a lack of concensus regarding these issues among major references and organizations.

Table 1
Full size table