Comparison of neonatal outcomes of term neonates with meconium-stained amniotic fluid before and after routine endotracheal suctioning strategy at birth.

OBJECTIVES: To compare the incidence of meconium aspiration syndrome (MAS) among neonates born through meconium-stained amniotic fluid (MSAF) before and after discontinuation of endotracheal suctioning for non-vigorous neonates. METHODS: We conducted a multicenter retrospective cohort study across three centers comparing two eras. Neonates born through MSAF at ≥36 weeks' gestation were included. Multivariable regression adjusted for sex and birth center. RESULTS: Among 8635 neonates (5554 Era 1; 3081 Era 2), including 1053 non-vigorous neonates, unadjusted MAS incidence did not differ between eras overall (4.8% vs. 5.5%, p = 0.17) or among non-vigorous neonates (21.0% vs. 22.8%, p = 0.55). After adjustment, Era 2 was associated with higher odds of MAS overall (aOR 1.37, 95% CI 1.11-1.69) and among non-vigorous neonates (aOR 1.54, 95% CI 1.07-2.22). Respiratory distress was higher in Era 2, while other outcomes assessed were unchanged. CONCLUSIONS: Discontinuation of routine suctioning was associated with increased MAS incidence among neonates born through MSAF.

Duke Scholars

Author Rachel Gottron Greenberg Pediatrics, Neonatology