Around 10% of babies are delivered with meconium (babies first faeces) staining of the amniotic fluid (MSAF). These babies are at risk of MSAF inhalation during delivery which can lead to the potentially lethal respiratory disease known as meconium aspiration syndrome (MAS). Suctioning of MSAF babies has been practised since the 1970s despite the lack of a randomised controlled trial to specifically assess the effectiveness of suctioning to prevent MAS.
Nestor Vain (University of Buenos Aires, Argentina) and colleagues randomised around 2500 babies from 11 Argentinian hospitals and 1 US hospital to receive either suctioning (at the mouth and nose) or no suction during delivery. There was no diffrence in outcomes between the two groups; around 4% of babies in both groups developed MAS, around 1–2% of babies required mechanical ventilation, and no statistically significant differences were found for other outcomes, including mortality.
Dr Vain comments: "We conclude that routine intrapartum oropharyngeal and nasopharyngeal suctioning of term-gestation, meconium-stained infants does not prevent MAS or its complications. We believe that consideration should be given to revision of present recommendations".
In an accompanying commentary (p 560), Marina Cuttini (Paediatric Hospital Bambino Gesù, Rome, Italy) discusses the implications of the study and ethical issues surrounding neonatal research. She comments: "Vain and colleagues' findings challenge current guidelines on perinatal treatment of the MSAF baby. Once again, since Archie Cochrane labelled obstetrics as the field with the largest number of unproven therapies in use, a widespread procedure has failed to pass the test of rigorous experimental evaluation".
Contact : Dr Nestor E Vain, Chenaut 1831, Piso 1, Buenos Aires (1426), Argentina;
T) 54-11-4127-5534;
vain@fibertel.com.ar
Dr Marina Cuttini, Unit of Epidemiology, Paediatric Hospital Bambino Gesù, Roma 00165, Italy;
T) (please add telephone number); cuttini@opbg.net
Journal
The Lancet