Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?

Munmun Rawat, Sushma Nangia, Praveen Chandrasekharan, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.

Original languageEnglish (US)
JournalAmerican Journal of Perinatology
DOIs
StateAccepted/In press - Jan 16 2018

Fingerprint

Meconium
Amniotic Fluid
Resuscitation
Meconium Aspiration Syndrome
Extracorporeal Membrane Oxygenation
Newborn Infant
Neonatal Intensive Care
Brain Hypoxia-Ischemia
Translational Medical Research
Positive-Pressure Respiration
Vocal Cords
Observational Studies
Ischemia
Air
Incidence

Keywords

  • hypoxia
  • meconium
  • pulmonary hypertension
  • suction

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Approach to Infants Born Through Meconium Stained Amniotic Fluid : Evolution Based on Evidence? / Rawat, Munmun; Nangia, Sushma; Chandrasekharan, Praveen; Lakshminrusimha, Satyanarayana.

In: American Journal of Perinatology, 16.01.2018.

Research output: Contribution to journalArticle

@article{7b7f9ff06cd64d54a59ebde132b21132,
title = "Approach to Infants Born Through Meconium Stained Amniotic Fluid: Evolution Based on Evidence?",
abstract = "Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.",
keywords = "hypoxia, meconium, pulmonary hypertension, suction",
author = "Munmun Rawat and Sushma Nangia and Praveen Chandrasekharan and Satyanarayana Lakshminrusimha",
year = "2018",
month = "1",
day = "16",
doi = "10.1055/s-0037-1620269",
language = "English (US)",
journal = "American Journal of Perinatology",
issn = "0735-1631",
publisher = "Thieme Medical Publishers",

}

TY - JOUR

T1 - Approach to Infants Born Through Meconium Stained Amniotic Fluid

T2 - Evolution Based on Evidence?

AU - Rawat, Munmun

AU - Nangia, Sushma

AU - Chandrasekharan, Praveen

AU - Lakshminrusimha, Satyanarayana

PY - 2018/1/16

Y1 - 2018/1/16

N2 - Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.

AB - Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress. Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved over the last three decades. Previously, nonvigorous neonates soon after delivery were suctioned under the vocal cords with direct visualization technique using a meconium aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning but favors resuscitation with positive pressure ventilation of nonvigorous neonates with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology, evolution and the evidence, randomized control trials, observational studies, and translational research to support these recommendations. The frequency of ECMO use for neonatal respiratory indication of MAS has declined over the years probably secondary to improvements in neonatal intensive care and reduction of postmaturity. Changes in resuscitation practices may have contributed to reduced incidence and severity of MAS. Larger randomized controlled studies are needed among nonvigorous infants with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct such studies.

KW - hypoxia

KW - meconium

KW - pulmonary hypertension

KW - suction

UR - http://www.scopus.com/inward/record.url?scp=85040795284&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85040795284&partnerID=8YFLogxK

U2 - 10.1055/s-0037-1620269

DO - 10.1055/s-0037-1620269

M3 - Article

C2 - 29341045

AN - SCOPUS:85040795284

JO - American Journal of Perinatology

JF - American Journal of Perinatology

SN - 0735-1631

ER -