The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years

HUANG Hai-Bo; ZHU Xiao-Yu; CHEUNG Po-Yin

doi:10.7499/j.issn.1008-8830.2209031

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Chinese Journal of Contemporary Pediatrics ›› 2023, Vol. 25 ›› Issue (3) : 229-237. DOI: 10.7499/j.issn.1008-8830.2209031

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The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years

HUANG Hai-Bo, ZHU Xiao-Yu, CHEUNG Po-Yin

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Abstract

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP^?) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP^? guidelines over the past 60 years.

Key words

Meconium-stained amniotic fluid / Suction / Meconium / Guideline / Neonate

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HUANG Hai-Bo, ZHU Xiao-Yu, CHEUNG Po-Yin. The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years[J]. Chinese Journal of Contemporary Pediatrics. 2023, 25(3): 229-237 https://doi.org/10.7499/j.issn.1008-8830.2209031

References

1 Matalon R, Wainstock T, Walfisch A, et al. Exposure to meconium-stained amniotic fluid and long-term neurological-related hospitalizations throughout childhood[J]. Am J Perinatol, 2021, 38(14): 1513-1518. PMID: 32620023. DOI: 10.1055/s-0040-1713863.
2 Wiswell TE. Appropriate management of the nonvigorous meconium-stained neonate: an unanswered question[J]. Pediatrics, 2018, 142(6): e20183052. PMID: 30385638. DOI: 10.1542/peds.2018-3052.
3 Chiruvolu A, Miklis KK, Chen E, et al. Delivery room management of meconium-stained newborns and respiratory support[J]. Pediatrics, 2018, 142(6): e20181485. PMID: 30385640. DOI: 10.1542/peds.2018-1485.
4 Addisu D, Asres A, Gedefaw G, et al. Prevalence of meconium stained amniotic fluid and its associated factors among women who gave birth at term in Felege Hiwot comprehensive specialized referral hospital, North West Ethiopia: a facility based cross-sectional study[J]. BMC Pregnancy Childbirth, 2018, 18(1): 429. PMID: 30376814. PMCID: PMC6208023. DOI: 10.1186/s12884-018-2056-y.
5 Hiersch L, Krispin E, Aviram A, et al. Effect of meconium-stained amniotic fluid on perinatal complications in low-risk pregnancies at term[J]. Am J Perinatol, 2016, 33(4): 378-384. PMID: 26479168. DOI: 10.1055/s-0035-1565989.
6 Brailovschi Y, Sheiner E, Wiznitzer A, et al. Risk factors for intrapartum fetal death and trends over the years[J]. Arch Gynecol Obstet, 2012, 285(2): 323-329. PMID: 21735187. DOI: 10.1007/s00404-011-1969-8.
7 Ohana O, Holcberg G, Sergienko R, et al. Risk factors for intrauterine fetal death (1988-2009)[J]. J Matern Fetal Neonatal Med, 2011, 24(9): 1079-1083. PMID: 21314292. DOI: 10.3109/14767058.2010.545918.
8 Oommen VI, Ramaswamy VV, Szyld E, et al. Resuscitation of non-vigorous neonates born through meconium-stained amniotic fluid: post policy change impact analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(3): 324-326. PMID: 32963086. DOI: 10.1136/archdischild-2020-319771.
9 Edwards EM, Lakshminrusimha S, Ehret DEY, et al. NICU admissions for meconium aspiration syndrome before and after a national resuscitation program suctioning guideline change[J]. Children (Basel), 2019, 6(5): 68. PMID: 31067816. PMCID: PMC6560382. DOI: 10.3390/children6050068.
10 Gregory GA, Gooding CA, Phibbs RH, et al. Meconium aspiration in infants: a prospective study[J]. J Pediatr, 1974, 85(6): 848-852. PMID: 4472964. DOI: 10.1016/s0022-3476(74)80358-6.
11 Carson BS, Losey RW, Bowes WA, et al. Combined obstetric and pediatric approach to prevent meconium aspiration syndrome[J]. Am J Obstet Gynecol, 1976, 126(6): 712-715. PMID: 984149. DOI: 10.1016/0002-9378(76)90525-1.
12 James LS. Resuscitation of the Newborn Infant[M]. St. Louis, MO: CV Mosby Co, 1960: 141-160.
13 Bloom RS, Cropley C. Textbook of Neonatal Resuscitation[M]. Elk Grove Village (IL): American Academy of Pediatrics, 1987.
14 Bloom RS, Cropley C. Textbook of Neonatal Resuscitation[M]. 2nd ed. Elk Grove Village (IL): American Academy of Pediatrics, 1990.
15 Bloom RS, Cropley C. Textbook of Neonatal Resuscitation[M]. 3rd ed. Dallas, TX, USA: AHA/AAP Neonatal Resuscitation Steering Committee, American Academy of Pediatrics and American Heart Association, 1994.
16 Linder N, Aranda JV, Tsur M, et al. Need for endotracheal intubation and suction in meconium-stained neonates[J]. J Pediatr, 1988, 112(4): 613-615. PMID: 3351688. DOI: 10.1016/s0022-3476(88)80183-5.
17 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[J]. Pediatrics, 2000, 105(1 Pt 1): 1-7. PMID: 10617696. DOI: 10.1542/peds.105.1.1.
18 Anon. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 11: neonatal resuscitation. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation[J]. Circulation, 2000, 102(8 Suppl): I343-I357. PMID: 10966680.
19 Kattwinkel J. Textbook of Neonatal Resuscitation[M]. 4th ed. Washington, DC: American Academy of Pediatrics, 2000: 2-7.
20 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[J]. Lancet, 2004, 364(9434): 597-602. PMID: 15313360. DOI: 10.1016/S0140-6736(04)16852-9.
21 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. ACOG Committee Opinion No. 379: management of delivery of a newborn with meconium-stained amniotic fluid[J]. Obstet Gynecol, 2007, 110(3): 739. PMID: 17766627. DOI: 10.1097/01.AOG.0000263928.82639.7f.
22 American Heart Association. 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: pediatric basic life support[J]. Pediatrics, 2006, 117(5): e989-e1004. PMID: 16651298. DOI: 10.1542/peds.2006-0219.
23 Kattwinkel J. Textbook of Neonatal Resuscitation[M]. 5th ed. Elk Grove Village, IL: American Academy of Pediatrics, American Heart Association, 2006: 53.
24 Kattwinkel J. Textbook of Neonatal Resuscitation[M]. 6th ed. Elk Grove Village: American Academy of Pediatrics, American Heart Association, 2011: 42-44.
25 Perlman JM, Wyllie J, Kattwinkel J, et al. Part 11: neonatal resuscitation: 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2010, 122(16 Suppl 2): S516-S538. PMID: 20956259. DOI: 10.1161/CIRCULATIONAHA.110.971127.
26 Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2015, 132(18 Suppl 2): S543-S560. PMID: 26473001. DOI: 10.1161/CIR.0000000000000267.
27 American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation[M]. 7th ed. Elk Grove Village, IL, USA: American Academy of Pediatrics, 2016: 51-53.
28 Al Takroni AM, Parvathi CK, Mendis KB, et al. Selective tracheal suctioning to prevent meconium aspiration syndrome[J]. Int J Gynaecol Obstet, 1998, 63(3): 259-263. PMID: 9989895. DOI: 10.1016/s0020-7292(98)00172-6.
29 Peng TC, Gutcher GR, Van Dorsten JP. A selective aggressive approach to the neonate exposed to meconium-stained amniotic fluid[J]. Am J Obstet Gynecol, 1996, 175(2): 296-301. PMID: 8765245. DOI: 10.1016/s0002-9378(96)70138-2.
30 Yoder BA. Meconium-stained amniotic fluid and respiratory complications: impact of selective tracheal suction[J]. Obstet Gynecol, 1994, 83(1): 77-84. PMID: 8272313.
31 Davis RO, Philips JB, Harris BA, et al. Fatal meconium aspiration syndrome occurring despite airway management considered appropriate[J]. Am J Obstet Gynecol, 1985, 151(6): 731-736. PMID: 3976781. DOI: 10.1016/0002-9378(85)90506-x.
32 Dooley SL, Pesavento DJ, Depp R, et al. Meconium below the vocal cords at delivery: correlation with intrapartum events[J]. Am J Obstet Gynecol, 1985, 153(7): 767-770. PMID: 4073141. DOI: 10.1016/0002-9378(85)90342-4.
33 Hageman JR, Conley M, Francis K, et al. Delivery room management of meconium staining of the amniotic fluid and the development of meconium aspiration syndrome[J]. J Perinatol, 1988, 8(2): 127-131. PMID: 3193263.
34 Manganaro R, Mamì C, Palmara A, et al. Incidence of meconium aspiration syndrome in term meconium-stained babies managed at birth with selective tracheal intubation[J]. J Perinat Med, 2001, 29(6): 465-468. PMID: 11776676. DOI: 10.1515/JPM.2001.065.
35 Rossi EM, Philipson EH, Williams TG, et al. Meconium aspiration syndrome: intrapartum and neonatal attributes[J]. Am J Obstet Gynecol, 1989, 161(5): 1106-1110. PMID: 2589429. DOI: 10.1016/0002-9378(89)90643-1.
36 Suresh GK, Sarkar S. Delivery room management of infants born through thin meconium stained liquor[J]. Indian Pediatr, 1994, 31(10): 1177-1181. PMID: 7875776.
37 Chettri S, Adhisivam B, Bhat BV. Endotracheal suction for nonvigorous neonates born through meconium stained amniotic fluid: a randomized controlled trial[J]. J Pediatr, 2015, 166(5): 1208-1213.e1. PMID: 25661412. DOI: 10.1016/j.jpeds.2014.12.076.
38 Aziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care[J]. Circulation, 2020, 142(16_suppl_2): S524-S550. PMID: 33081528. DOI: 10.1161/CIR.0000000000000902.
39 Wyckoff MH, Wyllie J, Aziz K, et al. Neonatal life support: 2020 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations[J]. Circulation, 2020, 142(16_suppl_1): S185-S221. PMID: 33084392. DOI: 10.1161/CIR.0000000000000895.
40 American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resuscitation[M]. 8th ed. Itasca, IL, USA: American Academy of Pediatrics, 2021: 52-55.
41 Trevisanuto D, Strand ML, Kawakami MD, et al. Tracheal suctioning of meconium at birth for non-vigorous infants: a systematic review and meta-analysis[J]. Resuscitation, 2020, 149: 117-126. PMID: 32097677. DOI: 10.1016/j.resuscitation.2020.01.038.
42 Nangia S, Sunder S, Biswas R, et al. Endotracheal suction in term non vigorous meconium stained neonates: a pilot study[J]. Resuscitation, 2016, 105: 79-84. PMID: 27255954. DOI: 10.1016/j.resuscitation.2016.05.015.
43 Singh SN, Saxena S, Bhriguvanshi A, et al. Effect of endotracheal suctioning just after birth in non-vigorous infants born through meconium stained amniotic fluid: a randomized controlled trial[J]. Clin Epidemiol Glob Health, 2019, 7(2): 165-170. DOI: 10.1016/j.cegh.2018.03.006.
44 Kumar A, Kumar P, Basu S. Endotracheal suctioning for prevention of meconium aspiration syndrome: a randomized controlled trial[J]. Eur J Pediatr, 2019, 178(12): 1825-1832. PMID: 31588974. DOI: 10.1007/s00431-019-03463-z.
45 石树中, 邓蕊. 新生儿窒息抢救的体会[J]. 中华妇产科杂志, 1965, 11(5): 330-333.
46 关于新生儿窒息抢救方法的建议(1963年在江西省儿科学术会议上拟订)[J]. 中华儿科杂志, 1965, 14(2): 136-137. DOI: 10.3760/cma.j.issn.0578-1310.1965.02.130.
47 籍孝诚, 石树中, 胡皓夫, 等. 关于新生儿窒息复苏方法的建议[J]. 中华儿科杂志, 1983, 21(5): 299-301.
48 继续教育工作委员会. 中华医学会第十一届儿科学术会议专业工作委员会及学组学术总结(一)[J]. 中华儿科杂志, 1994, 32(2): 67-72. DOI: 10.3760/cma.j.issn.0578-1310.1994.02.101.
49 朱小瑜, 秦振庭. 新生儿窒息与复苏世纪忆瞻[J]. 新生儿科杂志, 2001, 16(6): 271-276. DOI: 10.3969/j.issn.1673-6710.2001.06.015.
50 石树中. 关于新生儿窒息复苏方法的建议[J]. 中华儿科杂志, 1994, 32(5): 301-302. DOI: 10.3760/cma.j.issn.0578-1310.1994.05.124.
51 曹绪梅, 虞人杰. 新生儿窒息胎粪污染的气管内吸引及吸肺防治[J]. 小儿急救医学杂志, 1995, 2(1): 22-23.
52 虞人杰, 翟燕, 郭璟, 等. 新生儿窒息复苏急救的进一步探讨(附178例分析)[J]. 实用儿科杂志, 1991, 6(4): 210-211.
53 谢丹宇, 王淑珍, 袁转弟. 气管插管冲洗治疗胎粪吸入综合征[J]. 实用儿科临床杂志, 2004, 19(4): 295-296. DOI: 10.3969/j.issn.1003-515X.2004.04.026.
54 乜之瑛, 朱小瑜, 陶飞. 气管冲洗防治胎粪吸入综合征的临床价值[J]. 小儿急救医学, 2004, 11(S1): 50-51.
55 Xu T, Wang HS, Ye HM, et al. Impact of a nationwide training program for neonatal resuscitation in China[J]. Chin Med J (Engl), 2012, 125(8): 1448-1456. PMID: 22613652.
56 中华医学会围产医学分会. 新生儿窒息复苏项目专家会议纪要[J]. 中华围产医学杂志, 2004, 7(3): 171-172. DOI: 10.3760/cma.j.issn.1007-9408.2004.03.013.
57 卫生部妇幼保健与社区卫生司, 虞人杰, 叶鸿瑁, 等. 新生儿窒息复苏指南(试行稿)[J]. 中华儿科杂志, 2005, 43(5): 381-384. DOI: 10.3760/cma.j.issn.0578-1310.2005.05.120.
58 苏晋琼, 朱小瑜, 杨传忠, 等. 体位引流辅助气管吸引对胎粪吸入综合征的防治效果[J]. 中国小儿急救医学, 2010, 17(5): 421-423. DOI: 10.3760/cma.j.issn.1673-4912.2010.05.016.
59 中国新生儿复苏项目专家组. 新生儿窒息复苏指南(2007北京修订)[J]. 中华围产医学杂志, 2007, 10(4): 219-223. DOI: 10.3760/cma.j.issn.1007-9408.2007.04.002.
60 中国新生儿复苏项目专家组. 新生儿复苏指南(2011年北京修订)[J]. 中华围产医学杂志, 2011, 14(7): 415-419. DOI: 10.3760/cma.j.issn.1007-9408.2011.07.007.
61 中国新生儿复苏项目专家组. 中国新生儿复苏指南(2016年北京修订)[J]. 中华围产医学杂志, 2016, 19(7): 481-486. DOI: 10.3760/cma.j.issn.1007-9408.2016.07.001.
62 中国新生儿复苏项目专家组, 中华医学会围产医学分会新生儿复苏学组. 中国新生儿复苏指南(2021年修订)[J]. 中华围产医学杂志, 2022, 25(1): 4-12. DOI: 10.3760/cma.j.cn113903-20211122-00967.
63 Qiao J, Wang Y, Li X, et al. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China[J]. Lancet, 2021, 397(10293): 2497-2536. PMID: 34043953. DOI: 10.1016/S0140-6736(20)32708-2.
64 Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the global burden of disease study 2013[J]. Lancet, 2014, 384(9947): 957-979. PMID: 24797572. PMCID: PMC4165626. DOI: 10.1016/S0140-6736(14)60497-9.
65 赵梓伶, 蒋莉华, 何琳坤, 等. 国内外新生儿死亡率、婴儿死亡率与5岁以下儿童死亡率关系研究[J]. 中国妇幼保健, 2016, 31(13): 2585-2588. DOI: 10.7620/zgfybj.j.issn.1001-4411.2016.13.03.
66 Nangia S, Pal MM, Saili A, et al. Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: a RCT[J]. Resuscitation, 2015, 97: 83-87. PMID: 26449871. DOI: 10.1016/j.resuscitation.2015.09.394.
67 金汉珍, 黄德珉, 官希吉. 实用新生儿学[M]. 2版. 北京: 人民卫生出版社, 1997: 357.
68 朱建幸, 周晓苓, 张旭东, 等. 重症胎粪吸入综合征患儿临床与死亡相关因素分析[J]. 中国实用儿科杂志, 2001, 16(5): 277-279. DOI: 10.3969/j.issn.1005-2224.2001.05.014.
69 Kalra VK, Lee HC, Sie L, et al. Change in neonatal resuscitation guidelines and trends in incidence of meconium aspiration syndrome in California[J]. J Perinatol, 2020, 40(1): 46-55. PMID: 31611615. DOI: 10.1038/s41372-019-0529-0.
70 Liu WF, Harrington T. The need for delivery room intubation of thin meconium in the low-risk newborn: a clinical trial[J]. Am J Perinatol, 1998, 15(12): 675-682. PMID: 10333394. DOI: 10.1055/s-2007-999301.
71 Cavallin F, Res G, Monfredini C, et al. Time needed to intubate and suction a manikin prior to instituting positive pressure ventilation: a simulation trial[J]. Eur J Pediatr, 2021, 180(1): 247-252. PMID: 32749547. PMCID: PMC7782398. DOI: 10.1007/s00431-020-03759-5.
72 Rawat M, Nangia S, Chandrasekharan P, et al. Approach to infants born through meconium stained amniotic fluid: evolution based on evidence?[J]. Am J Perinatol, 2018, 35(9): 815-822. PMID: 29341045. DOI: 10.1055/s-0037-1620269.
73 Sehgal A, Athikarisamy SE, Adamopoulos M. Global myocardial function is compromised in infants with pulmonary hypertension[J]. Acta Paediatr, 2012, 101(4): 410-413. PMID: 22181690. DOI: 10.1111/j.1651-2227.2011.02572.x.
74 Lapointe A, Barrington KJ. Pulmonary hypertension and the asphyxiated newborn[J]. J Pediatr, 2011, 158(2 Suppl): e19-e24. PMID: 21238701. DOI: 10.1016/j.jpeds.2010.11.008.
75 Kinsella JP. Inhaled nitric oxide in the term newborn[J]. Early Hum Dev, 2008, 84(11): 709-716. PMID: 18930613. DOI: 10.1016/j.earlhumdev.2008.08.002.
76 张家骧, 魏克伦, 薛辛东. 新生儿急救学[M]. 2版. 北京: 人民卫生出版社, 2006: 400-403.