A term infant is born through meconium-stained amniotic fluid. At birth the baby cries vigorously, has good muscle tone, and a heart rate of 140 bpm. What is the correct management of this infant's airway?
- A Routine care with warming, drying and skin-to-skin contact, no tracheal suctioning ✓
- B Immediate elective endotracheal intubation and tracheal suctioning
- C Oropharyngeal suctioning on the perineum before delivery of the shoulders
- D Continuous positive airway pressure prophylactically for 6 hours
Correct answer: A. Routine care with warming, drying and skin-to-skin contact, no tracheal suctioning
Explanation
Current neonatal resuscitation guidance holds that a vigorous infant born through meconium-stained liquor needs no airway intervention beyond routine care; routine intubation for tracheal suctioning does not improve outcome and causes complications. Intrapartum oropharyngeal suctioning on the perineum was abandoned after trials showed no benefit. Intubation and suction are considered only if the baby is depressed and there is airway obstruction that bag-mask ventilation cannot clear.
Reference: Cloherty and Stark's Manual of Neonatal Care, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.