The need for delivery room intubation of thin meconium in the low-risk newborn: A clinical trial

The delivery room management of meconium-stained amniotic fluid remains con troversial. We attempted to determine if intubation of the low-risk newborn with thin meconium affects the incidence of respiratory symptoms. Exclusio n criterion included moderate or thick meconium, fetal distress, neonatal d epression, or prematurity. Eligible infants were randomized to either an in tubation (group 1) or to a nonintubation group (group II). The outcome was the presence of respiratory symptoms. Patients were studied from May 1994 t o June 1997. There were 8967 births during this period: 7.9% (708/8967) wer e delivered through meconium. Thin meconium was noted in 50.3% (356/708) of all births. 24/356 infants with thin meconium were excluded for medical cr iterion. One hundred sixty-three infants were medically eligible but could not be randomized due to lack of consent, late arrival of the team, or obst etrician request. These were placed into intubation (group I B) and nonintu bation (group It B) groups. Seventy-seven infants were randomized into grou p I and 92 infants into group It. From the intubation groups I and I B, one required supplemental oxygen and was weaned to room air in 7 hr. From the nonintubation groups II and II B, two infants required oxygen, weaning to r oom air in 11 and 46 hr. Comparing birth weight, gestational age, sex, mode of delivery and 5-min Apgar, there were no significant differences. How ev er, the intubation groups had significantly lower I-min Apgar scores. There was no airway morbidity reported in the intubation groups. In the infant w ith thin meconium and an otherwise low-risk pregnancy, we were unable to de monstrate a difference in respiratory symptoms with intubation and intratra cheal suctioning.