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 intubatio n in meconium-exposed fetuses. STUDY DESIGN: All pregnancies delivered at the Medical College of Virginia in 1990 were included. Meconium wa s noted at membrane rupture and qualified as thick, moderate, or thin. Neonates underwent suctioning with a DeLee device at delivery They we re observed without endotracheal intubation if they fulfilled the foll owing criteria: vaginal delivery, gestational age > 37 weeks, birth we ight > 2500 gm, and anticipated Apgar score greater than or equal to 8 at 1 minute. RESULTS: Of 4289 deliveries, 659 were exposed to meconiu m and 48% of infants were intubated. Birth weights, gestational ages a t delivery, and umbilical arterial pH were similar between intubated a nd 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 intub ation. Meconium aspiration syndrome did not occur in the nonintubated group.