During the care of a baby born at 40 weeks of gestation, the resuscitation team remained focused on the removal of meconium from the trachea with multiple episodes of intubation and suctioning. This delayed early lung inflation and, hence, oxygenation in a profoundly hypoxic baby, who subsequently met the criteria for therapeutic hypothermia. The MRI scan undertaken at 11 days of age showed grade III HIE.
When reviewing the care of babies, reviewers found that, in particular, the management of babies born through meconium-stained liquor was variable. There were a number of babies whose care reflected this and the specialist reviewers highlighted a need to raise awareness of current International Liaison Committee on Resuscitation (ILCOR) recommendations relating to the initial approach to managing these babies.
Things you can do
The presence of thick viscous meconium in a nonvigorous baby is the only indication for considering visualisation of the oropharynx, and suctioning and tracheal intubation should only be performed for suspected tracheal obstruction.[i] Tracheal intubation may be considered at several points during neonatal resuscitation:
- when suctioning the lower airways to remove a presumed tracheal blockage, e.g. thick meconium secretions, mucus plug
- when, after correction of mask technique and/or the baby’s head position, bag mask ventilation is ineffective or prolonged
- when chest compressions are performed
- special circumstances, e.g. congenital diaphragmatic hernia, tracheal surfactant administration.[ii]
[i] Wyllie J, Bruinenberg J, Roehr CC, Rüdiger M, Trevisanuto D, Urlesberger B. European Resuscitation Council Guidelines for Resuscitation 2015: Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015; 95: 249–63 [http://ercguidelines.elsevierresource.com/european-resuscitation-council-guidelines-resuscitation-2015-section-7-resuscitation-and-support].
[ii] Wyllie J, Bruinenberg J, Roehr CC, Rudiger M, Trevisanuto D, Urlesberger B European Resuscitation Council Guidelines for Resuscitation 2015 Section 7. Resuscitation and support of transition of babies at birth. Resuscitation 2015; 95: 249-263. Available at: http://ercguidelines.elsevierresource.com/european-resuscitation-council-guidelines-resuscitation-2015-section-7-resuscitation-and-support [Accessed on 29th May]