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Meconium Still Happens :

April 4, 2017

For those clinicians who began practice in labor and delivery and the NICU in recent years, perhaps this latter message is worth emphasizing. With the latest ILCOR guidelines, there might be a perception that meconium is not worth worrying about since we no longer are suggesting routine intubation for suctioning of meconium. Of course, that is not quite right.

I appreciate the title of the article “Non-Delivery Room Management of Meconium Aspiration Syndrome,” by Dr. Puneet Kumar Arora in March NeoReviews:

At first glance at this title, I thought the article would be about our profession no longer performing interventions, such as suctioning at perineum or intubating to suction meconium for nonvigorous infants.

This “non-management” follows the latest 2015 guidelines from the International Liaison Committee on Resuscitation (ILCOR), reviewed in NeoReviews last August (“Highlights of the New Neonatal Resuscitation Program Guidelines”), as well as in a more detailed review (“Management of the Meconium-Stained Newborn”) in the same issue.  Hence, the implication of the title could have been, “Don’t do any management of meconium in the delivery room!”

But that is not what the article is about. Rather, I think Dr. Arora is saying, “There’s already been enough about the delivery room and meconium – let’s talk about management outside the delivery room!”

For those clinicians who began practice in labor and delivery and the NICU in recent years, perhaps this latter message is worth emphasizing. With the latest ILCOR guidelines, there might be a perception that meconium is not worth worrying about since we no longer are suggesting routine intubation for suctioning of meconium. Of course, that is not quite right.

Meconium at birth is still obviously a risk factor (a necessary risk factor, perhaps sufficient, although not absolute) for meconium aspiration syndrome. Also, given the trend toward fewer post-term deliveries over the past two decades, our workload in taking care of these patients has decreased as well and perhaps has created an impression among our trainees and younger colleagues that meconium is not that big of a big deal.

Therefore, as we know that meconium—and its aspiration—still happen from time to time, I appreciate the review by Dr. Arora introducing trainees to this serious disease, as well as helping us to review current strategies in the management of these patients outside of the delivery room.

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