A term infant is delivered through thick meconium stained amniotic fluid. At birth the baby has good respiratory effort, a heart rate of 140 bpm, and normal tone. According to current NRP recommendations, what is the appropriate management?

• A Routine direct laryngoscopy and tracheal suctioning before initiating any other step
• B Routine intrapartum oropharyngeal suctioning on the perineum followed by observation
• C Immediate intubation and mechanical ventilation for 24 hours as prophylaxis
• D Standard resuscitation steps; suction the airway only if the baby has obstruction or requires PPV ✓

Explanation

Current NRP guidance abandoned routine tracheal suctioning for meconium stained fluid because randomised trials showed no benefit and possible harm from delay in ventilation. A vigorous baby like this one needs only standard care with airway suctioning if there is actual obstruction. Routine intrapartum oropharyngeal suctioning was also shown not to reduce meconium aspiration syndrome and is no longer recommended.

Reference: Textbook of Neonatal Resuscitation (NRP), AAP/AHA, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.