Perspective on the paper by van Ierland et al (see page 69)

Meconium staining of the amniotic fluid (MSAF) commonly complicates delivery at or around term. Thick meconium is more likely than thin to cause associated lung disease and more asphyxiated infants have long been known to be at higher risk of lung disease.1

In addition, the incidence meconium aspiration syndrome (MAS) varies geographically,2 by gender and by ethnicity as well as by place of delivery (with planned home deliveries reported as being at more than twice the risk).3 Optimal management of the common condition of MSAF thus has the potential to result in marked improvements in worldwide health outcomes. Furthermore, there are suggestions of a temporal change in the rates of MAS, with a large cohort study of MAS showing a reduction in incidence over recent years, albeit only in those infants born at or after 41 weeks of gestation.3 Those and other authors have suggested that obstetric interventions were important in moderating the risk of MAS.3 4

Globally, neonatology’s approach to the management of MSAF has changed, most signally in response to the classic papers of Wiswell and colleagues1 and Vain et al.5 They showed that interventions after the delivery of the infant’s head do little to affect the incidence of MAS, despite the fact that a third of apparently vigorous infants born through MSAF have meconium in the trachea at delivery.1 Tracheal suction for “depressed” infants with meconium in the trachea remains recommended …