Suctioning doesn't alter meconium aspiration risk: intrapartum suctioning also did not change neonatal mortality rates. (Done Before Shoulder Delivery).

SAN FRANCISCO -- Intrapartum aspiration of term infants with meconium-stained amniotic fluid before shoulder delivery did not alter the risk for developing meconium aspiration syndrome in a prospective, randomized, controlled trial in 2,481 patients.

The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend oropharyngeal and nasopharyngeal suctioning of meconium-stained infants before delivery of the shoulders in an effort to prevent meconium aspiration syndrome.

"Consideration should be given to revising the current recommendations," Dr. Edgardo G. Szyld said at the annual meeting of the Society for Maternal-Fetal Medicine.

The syndrome occurred in 4% of 1,245 infants who received intrapartum suctioning and 4% of the control infants, said Dr. Szyld, who is a neonatologist at Diego Paroissien Hospital, Buenos Aires.

The current recommendations were based on a 1976 nonrandomized study that compared 173 meconium-stained infants with historical control infants and found only a nonsignificant trend suggesting some benefit from this procedure, which is performed in millions of deliveries annually worldwide.

The current trial, conducted at 11 Argentinian medical centers and the State University of New York, Stony Brook, used computerized randomization to assign women to two groups just before delivery. In one group, meconium-stained infants were suctioned before delivery of the shoulders; the other group had no suctioning. After birth, no other suctioning was done in either group, except when clinicians noted airway obstruction.

Subsequently a similar historical-comparison trial in 1988 and a 1992 observational comparison of infants suctioned before or after delivery of the shoulders failed to find any benefit from suctioning before ...