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Letter to the editor

Indian Pediatrics 2001; 38: 434-435  

Delivery Room Management of Neonates Born Through Meconium Stained Amniotic Fluid


We read the recent publication(1) on this subject with interest. The authors have mentioned – "whether all babies born through thin meconium should undergo immediate postnatal endotracheal suctioning is a point of controversy"(1). The present international guidelines for neonatal resuscitation do not base management of neonates born through meconium stained amniotic fluid on the consistency of meconium staining of amniotic fluid(2). As per the guidelines "When the amniotic fluid is meconium stained, suction the mouth, pharynx, and nose as soon as the head is delivered (intrapartum suctioning) regard-less of whether the meconium is thin or thick. Thorough suctioning of the nose, mouth, and posterior pharynx before delivery of the body appears to decrease the risk of meconium aspiration syndrome". There is evidence that "tracheal suctioning of the vigorous infant with meconium should not undergo routine tracheal suctioning" has ceased to be a matter of controversy.

The category of neonates with thin meconium and depression were an exclusion criterion in the study. A look at the results shows that their number has not been accounted for anywhere, since it does not figure in the 184 who were born through meconium stained amniotic fluid (MSAF), of the 1109 livelbirths. The authors have also not provided the numbers of vigorous and depressed neonates in thick MSAF group.

Alloting alternate patients in group II to intubation vs no intubation is non-random, and prone to bias.

Apgar score being an ordinal, its Mean ± SD can not be comapred between groups.

Daljit Singh,
Sourabh Dutta,
Division of Neonatology
Department of Pediatrics
Post Graduate Institute of Medical Education and Research,
Chandigarh 160 012,
India.

 References

Chaturvedi P, Yadav B, Bharambe MS. Delivery Room Management of neonates born through meconium stained amniotic fluid. Indian Pediatr 2000;37: 1251-1255.

International Guidelines for Neonatal Resus-citation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emer-gency Cardiovascular Care: International Consensus on Science. Pediatrics 2000; 106: e29.

Wiswell TE, Gannon CM, Jacob J. Meconium in the Delivery Room Trial Group. Delivery room management of the apparently vigorous meconium stained neonate: Results of the multicenter collaborative trial. Pediatrics 2000; 105: 1-7.

 Reply

We agree that the recently published inter-national guidelines for neonatal resuscitation do not base management of neonates born through meconium stained amniotic fluid on the consistency of meconium staining of the amniotic fluid(1). But it must be noted that these guidelines were published in September 2000, whereas our study(2) was conducted in 1997-1998 when disagreement existed concerning the appropriate delivery room management of the airway of vigorous meconium stained infants. On the basis of this controversy, a multicenter international colla-borative trial was also conducted the results of which were published in January 2000(3). Their conclusion was the same as that of our study. The flow chart in the study depicts only 184 neonates born through meconium stained amniotic fluid (MSAF) who were included in the study. One neonate born through this MSAF and depressed was not included in the flow chart. Hence the total babies born through MSAF should read 185 instead of 184. We are sorry for this error.

The number of depressed infants in the thick meconium group were 10. This data was earlier submitted in the original paper but was deleted as per the reviewers suggestion and instead it was suggested that mean and SD of APGAR at 1 min and 5 min of both groups should be included among the variables.

We agree that a random sample would have been better.

Pushpa Chaturvedi,
Balraj Yadav,
M.S. Bharambe,
Department of Pediatrics,
Mahatma Gandhi Institute of Medical Sciences,
Sevagram 442 102, India.

 References
  1. International Guidelines for Neonatal Resuscitation: An excerpt from the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Pediatric 2000; 106: e29.

  2. Chaturvedi P, Yadav B, Bharambe M. Delivery room management of neonates born through meconium stained amniotic fluid. Indian Pediatr 2000; 37: 1251-1255.

  3. Wiswell TE, Gannon CM, Jacob J. Meconium in the Delivery Room Trial Groups Delivery room management of the apparently vigorous meconium stained neonate: Results of the multicenter collaborative trial. Pediatrics 2000; 105: 1-7.

 

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