A term infant is delivered through thickly meconium-stained amniotic fluid. At birth she cries vigorously, has good tone, and a heart rate of 140 bpm. What is the appropriate management?
- A Routine newborn care with drying and stimulation, without routine tracheal suctioning ✓
- B Routine intrapartum oropharyngeal suctioning followed by nasal suctioning at delivery
- C Routine tracheal suctioning only if the heart rate falls below 100 bpm
- D Immediate laryngoscopy and endotracheal suctioning before initiating resuscitation
Correct answer: A. Routine newborn care with drying and stimulation, without routine tracheal suctioning
Explanation
Current NRP guidance recommends against routine intrapartum suctioning and against routine laryngoscopy and tracheal suctioning for infants born through meconium-stained fluid, even if the fluid is thick. D vigorous infant with good respirations, tone and heart rate should receive standard care. Tracheal suctioning is reserved for the infant who is not vigorous and in whom airway obstruction is suspected, so option D would apply only to a depressed baby.
Reference: Textbook of Neonatal Resuscitation (NRP), American Academy of Pediatrics, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.