A selective aggressive approach to the neonate exposed to meconium-stained amniotic fluid

OBJECTIVE: We attempted to determine the effect on meconium aspiration syndrome from a selective approach of neonatal endotracheal intubation in meconium-exposed fetuses. STUDY DESIGN: All pregnancies delivered at the Medical College of Virginia in 1990 were included. Meconium was noted at membrane rupture and qualified as thick, moderate, or thin. Neonates underwent suctioning with a DeLee device at delivery They were observed without endotracheal intubation if they fulfilled the following criteria: vaginal delivery, gestational age > 37 weeks, birth weight > 2500 gm, and anticipated Apgar score greater than or equal to 8 at 1 minute. RESULTS: Of 4289 deliveries, 659 were exposed to meconium and 48% of infants were intubated. Birth weights, gestational ages at delivery, and umbilical arterial pH were similar between intubated and nonintubated neonates. Neonatal intensive care unit admissions were significantly higher in intubated neonates. All 9 neonates diagnosed with meconium aspiration syndrome were intubated at birth. CONCLUSIONS: Utilization of this protocol resulted in reduction of neonatal intubation. Meconium aspiration syndrome did not occur in the nonintubated group.