How does the resuscitation of the newly born infant differ if meconium is present in the amniotic fluid

How does the resuscitation of the newly born infant differ if meconium is present in the amniotic fluid? 

Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for meconium-stained infants. Routine endotracheal intubation and direct tracheal suctioning of meconium-stained infants was also shown to be of no value in a randomized control trial. Perform endotracheal suction for nonvigorous or “depressed” infants (decreased tone, absent or depressed respirations, or a heart rate less than 100 beats per minute) with meconium-stained amniotic fluid. This is accomplished by suctioning while withdrawing the endotracheal tube from the airway. Repeat intubation with suctioning until no more meconium is suctioned. If the heart rate falls below 60 beats per minute, keep the endotracheal tube in place and initiate positive-pressure ventilation. Meconium-stained newborns who develop respiratory depression should receive tracheal suctioning prior to positive-pressure ventilation. 

Sources

Vain NE, Szyld EG, Prudent LM, et al: Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: Multicentre, randomised controlled trial. Lancet 2004;364:597-602. 

Wiswell TE, Gannon CM, Jacob J, et al: Delivery room management of the apparently vigorous meconium stained neonate: Results of the multicenter, international collaborative trial. Pediatrics 2000;105:1-7.

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