A post-term neonate born at 41 weeks through thick meconium stained amniotic fluid is vigorous at birth with good tone and respirations above 100 bpm. According to current neonatal resuscitation guidelines, what should be done regarding airway management at birth?
- A Routine intrapartum oropharyngeal and nasopharyngeal suctioning before delivery of the shoulders
- B Routine suctioning of the mouth and nose after delivery only if the baby has obstructed breathing or requires positive pressure ventilation ✓
- C Immediate intubation and tracheal suctioning regardless of condition
- D No suctioning under any circumstance
Correct answer: B. Routine suctioning of the mouth and nose after delivery only if the baby has obstructed breathing or requires positive pressure ventilation
Explanation
Current NRP guidance does not recommend routine intrapartum suctioning or automatic tracheal suctioning of vigorous meconium-stained infants, as trials showed no benefit and possible harm from vagal stimulation. Suctioning is performed after birth only if there is airway obstruction or if positive pressure ventilation becomes necessary. The absolute prohibition in option D is wrong because suctioning remains indicated when obstruction compromises ventilation.
Reference: Fanaroff and Martin's Neonatal-Perinatal Medicine, 11th ed.
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Written and medically reviewed by the StethoPrep medical team.