A term neonate with meconium-stained amniotic fluid is born vigorous (crying, good tone, HR >100). Regarding management of the airway, what is the current NRP (2015 onwards) recommendation?
- A Immediate intubation and suctioning of the trachea before stimulation
- B Perform direct laryngoscopy and intubate only if there is thick particulate meconium
- C Clear mouth and nose with bulb syringe, then proceed with standard resuscitation steps ✓
- D Suction the oropharynx deeply with a 10 Fr catheter before delivering the shoulders
Correct answer: C. Clear mouth and nose with bulb syringe, then proceed with standard resuscitation steps
Explanation
Since the 2015 NRP revision, routine intubation and tracheal suctioning are no longer recommended for vigorous meconium-stained neonates, as randomised controlled trials showed no benefit and potential harm. For a vigorous neonate (strong cry, good muscle tone, HR >100), the current approach is to clear secretions from the mouth/nose with a bulb syringe and proceed with standard warming, drying, and stimulation steps. Tracheal intubation and suction is reserved for non-vigorous neonates (absent cry, poor tone, HR <100).
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.