Delivery room management of the apparently vigorous meconium-stained neonate: Results of the multicenter, international collaborative trial

Objective. Disagreement exists concerning the appropriate delivery room man agement of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such n eonates, whereas others advocate a selective approach. We performed this in vestigation: 1) to assess whether intubation and suctioning of apparently v igorous, meconium-stained neonates would reduce the incidence of meconium a spiration syndrome (MAS); and 2) to determine the frequency of complication s from delivery room intubation and suctioning of such infants. Methods. Inclusion criteria included: 1) gestational age greater than or eq ual to 37 weeks; 2) birth through meconium-stained amniotic fluid of any co nsistency; and 3) apparent vigor immediately after birth. Subjects were ran domized to be intubated and suctioned (INT) or to expectant management (EXP ). Primary outcome measures included: 1) the incidence of respiratory distr ess, including MAS, and 2) the incidence of complications from intubation. Results. A total of 2094 neonates were enrolled from 12 participating cente rs (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demons trated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings a ttributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the develop ment of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 succe ssfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in natu re. Conclusions. Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a dec reased incidence of MAS or other respiratory disorders. Complications of in tubation are infrequent and short-lived.