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Approach to non-vigorous infants born through meconium-stained amniotic fluid—differences between randomized and observational studies

Journal of Perinatology volume 43, pages 129–130 (2023)Cite this article

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We thank Dr. Manzar for his interest [1] in our single-center study on the impact of change in tracheal suction guidelines for non-vigorous infants born through meconium-stained amniotic fluid (MSAF) [2]. We agree that while the incidence of NICU admission for respiratory indications increased in the no-suction era (17.9% vs. 60%), duration of respiratory support, mechanical ventilation, and hospital stay showed a non-significant decrease. While this may suggest reduced severity of illness, the small number of patients in this study and lack of statistical significance prevent us from making definitive conclusions or implying causation. Chiruvolu et al reported a similar increase in respiratory admissions in the no-suction era in their single-center study but did not observe any difference in duration of oxygen therapy (4.4 ± 4.6 vs. 6.4 ± 6.8 d), mechanical ventilation (1.3 ± 2.6 vs. 2.1 ± 3.9 d) or length of stay (7.7 ± 6.3 vs. 9.1 ± 11 d) [3].

The current dilemma is the differing results from small RCTs from India [4] and results based on two single-center observational studies from the US (Fig. 1). Although trials from India and studies from the US have similar incidence of low Apgar scores at 1 and 5 min, Indian RCTs demonstrate a high mortality and incidence of meconium aspiration syndrome (MAS) and hypoxic-ischemic encephalopathy (HIE) compared to US studies. In contrast, unadjusted analysis of pooled US data suggests higher incidence of MAS, and respiratory admissions in the no-routine-suction era compared to routine-suction era (Fig. 1). Similar to studies evaluating fluid boluses in pediatric shock, antenatal glucocorticoids in preterm labor, and therapeutic hypothermia for HIE, the impact of tracheal suctioning of non-vigorous infants born through MSAF may be different between both low-and-middle-income countries (LMIC) and high-income-countries (HIC). A multicenter randomized trial recruiting a large number of neonates from both LMIC and HIC is difficult to conduct but is desperately needed to determine the right approach to tracheal suctioning in non-vigorous infants born through MSAF.

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Fig. 1: Comparison of findings from 4 randomized trials from India [4] and 2 observational studies from the US [2, 3] evaluating the impact of routine tracheal suctioning on the incidence of meconium aspiration syndrome (MAS), hypoxic-ischemic encephalopathy (HIE), persistent pulmonary hypertension of the newborn (PPHN), admission to the neonatal intensive care unit (NICU), respiratory admissions and frequency of low Apgar scores.

References

  1. Manzar S. Non-vigorous newborn infants and role of tracheal suctioning. J Perinat: Off J Calif Perinat Assoc. 2022.

  2. Kalra V, Leegwater AJ, Vadlaputi P, Garlapati P, Chawla S, Lakshminrusimha S. Neonatal outcomes of non-vigorous neonates with meconium-stained amniotic fluid before and after change in tracheal suctioning recommendation. J Perinat: Off J Calif Perinat Assoc. 2022;42:769–74.

    Article  CAS  Google Scholar 

  3. Chiruvolu A, Miklis KK, Chen E, Petrey B, Desai S. Delivery Room Management of Meconium-Stained Newborns and Respiratory Support. Pediatrics. 2018;142:e20181485.

    Article  Google Scholar 

  4. Trevisanuto D, Strand ML, Kawakami MD, Fabres J, Szyld E, Nation K, et al. Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis. Resuscitation. 2020;149:117–26.

    Article  Google Scholar 

  5. Wyckoff MH, Weiner CGM. Neonatal Life Support C. 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Pediatrics 2021;147(Suppl 1).

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Authors and Affiliations

  1. Department of Pediatrics, UC Davis, Sacramento, CA, USA

    Satyan Lakshminrusimha, Alexandra Leegwater & Pranjali Vadlaputi

  2. Newborn Specialists of Tulsa, Ascension St. John Medical Center, Tulsa, OK, USA

    Pranav Garlapati

  3. Department of Pediatrics, Detroit Medical Center, Detroit, MI, USA

    Sanjay Chawla

  4. Kaiser Permanente, San Leandro, CA, USA

    Vaneet Kalra

Authors
  1. Satyan Lakshminrusimha
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  2. Alexandra Leegwater
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  3. Pranjali Vadlaputi
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  4. Pranav Garlapati
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  5. Sanjay Chawla
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  6. Vaneet Kalra
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Contributions

VK: Data analysis and interpretation, article draft, critical revision; AL: Critical revision; PV: Data analysis and interpretation; PG: Data collection, data analysis, and interpretation, article draft; SC: Critical revision; SL: Article draft, critical revision, and final approval.

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Correspondence to Alexandra Leegwater.

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Dr. Satyan Lakshminrusimha is a member of the AAP-NRP steering committee. The views expressed in this letter are his own and do not reflect the official position of AAP, NRP or ILCOR.

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Lakshminrusimha, S., Leegwater, A., Vadlaputi, P. et al. Approach to non-vigorous infants born through meconium-stained amniotic fluid—differences between randomized and observational studies. J Perinatol 43, 129–130 (2023). https://doi.org/10.1038/s41372-022-01474-7

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