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