Safe and Successful Delivery-Room Intubation and Resuscitation of Meconium-Stained Newborns by Respiratory Therapists

Abstract

Prompt suctioning of the airways of meconium-stained infants at delivery reduces the incidence of disease associated with meconium-stained fluid (MSF). At Rogue Valley Medical Center in Medford, Oregon, trained respiratory therapists identify such infants needing intubation and perform the intubation and resuscitation in the delivery room. This study analyzed the effects of resuscitation by respiratory therapists who were called to the deliveries of infants with suspected MSF over a 5-month period. Method: I examined charts to tabulate data on meconium consistency (particulate or watery); whether births were vaginal or cesarean; whether intubation was performed and, if so, whether by a therapist or physician; and number of intubations per patient. I also tabulated outcome in terms of incidence of meconium aspiration syndrome (MAS), admission to the NICU, laryngeal complications of intubation, pulmonary air leak, and survival. Results: In the course of 700 consecutive births, 100 calls were made for respiratory therapists to attend deliveries of MSF babies; 74 babies were intubated, 69 by therapists. All 74 babies survived, and no laryngeal complications related to intubation occurred. Of the MSF babies whom therapists decided did not require intubation, none suffered subsequent respiratory distress. The rate of MAS was 1%, which is higher than that of another group of investigators who performed intrapartum oropharyngeal suctioning on all MSF babies; consequently, we are revising our protocol to place more emphasis on oropharyngeal suctioning and less on direct tracheal suctioning. Conclusion: I believe that the results of this study support the hypothesis that well-trained respiratory therapists can safely and successfully perform delivery-room resuscitation procedures involving newborns with meconium-stained fluid.