Intratracheal Suctioning, Systemic Infection, and the Meconium Aspiration Syndrome

A retrospective analysis was performed to determine: (1) the proportion of neonates with the meconium aspiration syndrome (MAS) who were not depressed at birth; (2) to evaluate the clinical course of neonates with MAS, particularly relating to whether or not delivery room intubation and intratracheal suctioning had taken place; and (3) to examine the incidence of culture-proven bacteremia among meconium-stained neonates and those with MAS. The medical records of all meconium-stained neonates and those with MAS admitted to our facility from 1985 through 1989 were reviewed. Of 5697 liveborn neonates, 741 (13%) were meconium-stained, of whom 608 (82%) were intubated and suctioned in the delivery room. No complications of the intubation/suctioning procedure were noted in these neonates. Forty-five neonates had culture-proven bacteremia. Five bacteremic neonates had been meconiumstained (0.7% of all such neonates), while 40 were not stained (0.8% incidence). Of 36 neonates with MAS, 1 (2.8%) was bacteremic. Twenty (56%) of 36 newborns with MAS did not require positive pressure ventilation in the delivery room. Twelve (33%) of the babies with MAS had not been intubated and suctioned in the delivery room. Nine (75%) of 12 nonsuctioned neonates, as well as 6 (25%) of 24 suctioned neonates, required mechanical ventilation for more than 6 hours (P = .010). Pneumothoraces occurred in 6 (50%) of 12 nonsuctioned and 5 (21%) of 24 suctioned babies (P = .125). Four of 12 nonsuctioned newborns either died (n = 1) or required extracorporeal membrane oxygenation (n = 3), while only 1 of the suctioned newborns required extracorporeal membrane oxygenation (P = .034). It is concluded that (1) delivery room intubation of meconium-stained neonates appears to be a procedure with a low incidence of complications; (2) a substantial proportion of neonates in whom MAS subsequently develops do not require resuscitation at birth; (3) neonates who develop MAS after not having been suctioned may be at increased risk for adverse sequelae; and (4) there is no evidence for an increased incidence of bacteremia among meconium-stained neonates.