Abstract
Meconium-stained amniotic fluid (MSAF) during delivery is a marker of fetal stress.
Neonates born through MSAF often need resuscitation and are at risk of meconium aspiration
syndrome (MAS), air leaks, hypoxic-ischemic encephalopathy, extracorporeal membrane
oxygenation (ECMO), and death. The neonatal resuscitation approach to MSAF has evolved
over the last three decades. Previously, nonvigorous neonates soon after delivery
were suctioned under the vocal cords with direct visualization technique using a meconium
aspirator. The recent neonatal resuscitation program (NRP) recommends against suctioning
but favors resuscitation with positive pressure ventilation of nonvigorous neonates
with MSAF. This recommendation is aimed to prevent delay in resuscitation and minimize
hypoxia-ischemia often associated with MSAF. In this review, we discuss the pathophysiology,
evolution and the evidence, randomized control trials, observational studies, and
translational research to support these recommendations. The frequency of ECMO use
for neonatal respiratory indication of MAS has declined over the years probably secondary
to improvements in neonatal intensive care and reduction of postmaturity. Changes
in resuscitation practices may have contributed to reduced incidence and severity
of MAS. Larger randomized controlled studies are needed among nonvigorous infants
with MSAF. However, ethical dilemmas and loss of equipoise pose a challenge to conduct
such studies.
Keywords
meconium - suction - hypoxia - pulmonary hypertension
