Effect Of Endotracheal Suctioning After Birth In Nonvigorous Infants Born Through Meconium Stained Amniotic Fluid

Background Lacking of strong evidence,American Academy of Pediatrics(AAP)in the United States has no longer recommended routine endotracheal intubation for meconium suction in inactive newborns with meconium-stained amniotic fluid,but only recommended intratracheal aspiration of feces if meconium blockage or airway obstruction was suspected to be occurred since 2015 and proposed that further confirmation was still needed by more researches.Guidelines for Neonatal Resuscitation in China(revised in Beijing in 2016)still recommended to assess active conditions of newborns with meconium-stained amniotic fluid according to China’s national conditions and practical experience: immediate preliminary resuscitation was needed for active neonates,those without vitality should be conducted endotracheal intubation at 20 s,and meconium suction by meconium suction tube,and those unavailable for endotracheal intubation should given immediate positive pressure ventilation after rapid cleaning of mouth and nose.At present,controversies on neonatal resuscitation of inactive newborns with meconium-stained amniotic fluid in the latest guidelines in China and abroad still exist,and further researches are needed due to insufficient studies on correlation between resuscitation and prognosis.Objective In this study,we discussed whether endotracheal intubation for meconium suction in inactive newborns with meconium-stained amniotic fluid could reduce incidence of meconium aspiration syndrome(MAS)and other respiratory problems,mortality rate,and shorten hospital stay,so as to evaluate its clinical effect on resuscitation.Materials and Methods1 A cohort study was conducted to retrospectively collect the hospitalized inactive newborns with meconium-stained amniotic fluid in Pediatric Department of our hospital.The non-vigorous neonates with meconium-stained amniotic fluid from July 1,2017 to June 30,2018 without endotracheal intubation were collected as non-intubation suction group(n=80,control group),including 42 males and 38 females,with gestational age of(40.3±3.7)weeks and body mass of(3407.8±671.7)g.Those from July 1,2018 to June 30,2019 with endotracheal intubation for meconium suction were selected as endotracheal intubation suction group(n=71,suction group),including 34 males and 37 females,with gestational age of(40.2±1.1)weeks and average weight of(3439.1±632.5)g.The neonates in the control group was given immediate preliminary resuscitation and positive pressure ventilation after rapid cleaning of mouth and nose after birth,while those in the suction group performed endotracheal intubation at 20 s,implemented meconium suction by meconium suction tube and preliminary resuscitation afterwards.The neonates with metabolic diseases,premature infants,congenital malformations(such as diaphragmatic hernia,pulmonary agenesis,etc.)and congenital heart disease were excluded in the study.The differences in oxygen inhalation,respiratory support,PS application,the number of deaths,as well as the incidence of complications between the two groups were compared,and the effects in shortening the time of oxygen inhalation,respiratory support and hospital stay of two groups were compared.2 All the data collected in the study was performed by SPSS 25.0 software,and the comparison of continuous data in accordance with normal distribution was expressed by mean ± standard deviation(x ±s),and made by t test.The proportions and ratios of categorical data were made by chi-square test.The results of the study was expressed by95% confidence interval(CI)and odds ratio(OR).A value of P less than 0.05 was considered significant.Results Mostly tracheal aspiration was conducted in the suction group.Compared with the control group,the ratios of patients who performed oxygen inhalation[11/71(15.5%)vs26/80(32.5%),P=0.015],noninvasive respiratory support[18/71(25.4%)vs 33/80(41.3%),P=0.039],mechanical ventilation[7/71(9.9%)vs 18/80(22.5%),P=0.037]in the suction group were lower than the control group(P<0.05),and the OR values were0.381(95%CI:0.172-0.843),0.484(95% CI: 0.241-0.970),0.435(95%CI:0.147-0.965),respectively.The average non-invasive ventilator time and hospital stay were shorter than that of the control group[(64.0±47.8 vs.75.0±47.6 h,P=0.023);(6.27±3.43 vs 7.89±4.33 d,P=0.013)].The incidence of complications such as MAS,persistent pulmonary hypertension of the newborn(PPHN),pneumothorax,occurrence of pneumorrhagia,and mortality rate were similar in two groups,and there were no significant between-group difference(P>0.05).Significant difference was found in noninvasive respiratory assistance time,since it was shorter in the suction group(P<0.05).Conclusions Immediate endotracheal meconium aspiration after birth for inactive meconium stained amniotic fluid(MSAF)newborns can reduce the proportion of hospitalized patients due to respiratory problems,shorten their length of hospital stay,and reduce the demands for oxygen therapy,noninvasive respiratory support,and mechanical ventilation.