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Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis
  1. Vinod Idicula Oommen1,
  2. Viraraghavan Vadakkencherry Ramaswamy1,
  3. Edgardo Szyld2,
  4. Charles Christoph Roehr1,3
  1. 1Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
  2. 2Division of Newborn Medicine, Department of Paediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
  3. 3National Perinatal Epidemiology Unit, University of Oxford Nuffield Department of Population Health, Oxford, Oxfordshire, UK
  1. Correspondence to Charles Christoph Roehr, Newborn Services, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; charles.roehr{at}


Background We investigated the impact of policy change in delivery room resuscitation from routine endotracheal (ET) suctioning of non-vigorous neonates born through meconium-stained amniotic fluid (MSAF) to immediate non-invasive respiratory support.

Design Single-centre cohort study. Prospective group (October 2016–September 2017)—non-vigorous neonates born through MSAF managed according to the current (2015) guidance of commencing respiratory support without prior suctioning. Retrospective group (August 2015–July 2016)—non-vigorous neonates born through MSAF who underwent routine ET suctioning.

Results 1138 neonates born through MSAF were analysed. No differences in the incidence of meconium aspiration syndrome (MAS), requirement of mechanical ventilation, inhaled nitric oxide or surfactant therapy were found between groups. Less neonatal intensive care unit (NICU) admissions were necessary in the prospective cohort compared with the retrospective group (19.1% vs 55.6%, respectively; p<0.05).

Conclusion The policy change towards not routinely suctioning non-vigorous neonates born through MSAF at birth was not associated with an increase in the local incidence of MAS and was associated with fewer NICU admissions.

  • resuscitation
  • neonatology
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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was classed as a service evaluation, which, according to the local ethics committees’ regulations, does not require ethics approval.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. The relevant data for this study are included in the original manuscript, which has been uploaded. There are no external links or sources where these data can be accessed. The included data are deidentified participant data.

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