Newborn. . .

TO SUCTION OR NOT TO SUCTION

Elsie D. Idulsa, MD 2/23/13

A. B. C. D.

BEmONC Australian Birth Forum, 2012 Newborn Baby Care to Giving Birth Naturally, Beier, 2012 Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomized controlled trial. Lancet 2004, Vain et al Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary 2/23/13 Resuscitation and Emergency

E.

A. Basic Emergency Obstetric and Newborn Care edit Master subtitle style (BEmONC) Click to

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Australian birth forum (Dec. 2012)

suctioning of a baby's nose and / or mouth at birth

last 5 years:

the value of this intervention, as a routine procedure, has been questioned

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Australian birth forum (Dec. 2012)

It is now believed that most healthy babies do not require any suctioning and are quite capable of clearing their airways on their own.

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Australian birth forum (Dec. 2012)

Fact:

babies, on average, are born with up to 75 to 100 mls of amniotic fluid in their lungs already (being fully absorbed within 24 hours after the birth) .
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Australian birth forum (Dec. 2012)

Newborn babies normally sound a little 'gurgly' when they breathe in the first hour after birth. This is normal and will usually resolve after an hour or so.

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Australian birth forum (Dec. 2012)

Other things a caregiver could do to remove some of the mucous is to:
Place

the baby on their stomach across the mother's belly, or sit the baby forward in the mother's arms.

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Australian birth forum (Dec. 2012)

Circumstances that would need the baby to require suctioning are generally limited to:
amniotic

fluid is HEAVILY stained with meconium the baby establish their breathing

help

(+) collection of thick mucous at the back of the baby's throat: use suction to 2/23/13 help the baby breathe more easily

Australian birth forum (Dec. 2012)

Healthy babies who cry spontaneously, with clear amniotic fluid, should not need any routine suctioning of their nose and mouth.

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Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicentre, randomized controlled trial. Lancet 2004, Vain NE, et al.

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It is standard procedure at hospital births to vigorously suction newborns' respiratory passages if the amniotic fluid is stained with meconium to prevent meconium aspiration syndrome.

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Researchers studied 2,514 full-term newborns with meconium-stained amniotic fluid at 12 different sites. One group was suctioned prior to delivery of the shoulders, the other group was not. Resuscitation was performed as needed after birth.
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Result: incidence of meconium aspiration symptoms was exactly the SAME (4 percent) in both groups

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This study SHOWS NO BENEFIT from a routine procedure performed on newborn babies and defies conventional wisdom. Suggestion: Now one more unnecessary intervention in neonatal care should be abandoned.
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Newborn Baby Care to Giving Birth Naturally

Catherine Beier, , 2012

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According to the International Guidelines for Neonatal Resuscitation (2000), only approximately 5-10% of newborns will require some degree of active resuscitation (stimulation to breathe) at birth, which can vary from simple skin rubbing to suctioning or full resuscitation.

90-95%

of all newborns need no assistance breathing at

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While it may seem wise to suction as soon as possible, the reality is that the baby is not at great risk of breathing difficulties at this point since it will typically not take its first breath until it has been fully birthed. 2/23/13

 suctioning

can be delayed until after the baby has been born CAN ONLY BE PERFORMED WHEN INDICATED rather than a routine procedure as most infants will be able to clear their own airways with no outside assistance
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SUCTIONING

Neonatal Resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
John Kattwinkel, Co-Chair,Jeffrey M. Perlman, Co-Chair, Khalid Aziz, Christopher Colby, Karen Fairchild, John Gallagher, Mary Fran Hazinski, Louis P. Halamek, Praveen Kumar, George Little, Jane E. McGowan, Barbara Nightengale, Mildred M. Ramirez, Steven Ringer, Wendy M. Simon, Gary M. Weiner, Myra Wyckoff, Jeanette Zaichkin

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 approximately

10% of newborns require some assistance to begin breathing at birth than 1% require extensive resuscitative measures
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less

INITIAL STEPS initial steps of resuscitation:

provide warmth by placing the baby under a radiant heat source positioning the head in a sniffing position to open the airway CLEARING THE AIRWAY IF NECESSARY WITH A BULB SYRINGE OR SUCTION CATHETER drying the baby stimulating breathing
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When Amniotic Fluid Is Clear

there

is evidence that suctioning of the nasopharynx can create BRADYCARDIA of the trachea in intubated babies receiving mechanical ventilation in the neonatal intensive care unit (NICU) can be associated with DETERIORATION OF PULMONARY COMPLIANCE AND OXYGENATION AND REDUCTION2/23/13 IN CEREBRAL BLOOD

suctioning

When Amniotic Fluid Is Clear

However,

there is also EVIDENCE THAT SUCTIONING IN THE PRESENCE OF SECRETIONS CAN DECREASE RESPIRATORY RESISTANCE. Therefore it is recommended that suctioning immediately following birth should BE RESERVED FOR BABIES WHO HAVE OBVIOUS OBSTRUCTION TO SPONTANEOUS BREATHING OR WHO REQUIRE POSITIVE-PRESSURE VENTILATION.
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When Meconium is Present

aspiration

of meconium before delivery, during birth, or during resuscitation can cause severe meconium aspiration syndrome(MAS) a variety of techniques have been recommended to reduce the incidence of MAS

historically

suctioning of the oropharynx before delivery of the shoulders was considered routine until 2/23/13 a randomized controlled

When Meconium is Present

elective

and routine endotracheal intubation and direct suctioning of the trachea were initially recommended for all meconiumstained newborns
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When Meconium is Present

randomized

controlled trial demonstrated that there was NO VALUE IN PERFORMING THIS PROCEDURE IN BABIES WHO WERE VIGOROUS AT BIRTH

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When Meconium is Present

depressed

infants born to mothers with meconium-stained amniotic fluid are at increased risk to develop MAS suctioning has not been associated with reduction in the incidence of MAS or mortality in these infants

tracheal

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The only evidence that direct tracheal suctioning of meconium may be of value was based on comparison of suctioned babies with historic controls, and there was apparent selection bias in the group of intubated babies included in those studies
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When Meconium is Present

in

the absence of randomized, controlled trials, there is INSUFFICIENT EVIDENCE to recommend a change in the current practice of performing endotracheal suctioning of nonvigorous babies with meconium-stained amniotic fluid if attempted intubation is prolonged and unsuccessful, bag-mask ventilation should be considered, particularly2/23/13 if there is persistent

however,

Conclusion:
BEmONC do not suction unless the mouth or nose are blocked by secretions recommended that suctioning immediately following birth should be reserved for babies who have obvious obstruction to spontaneous breathing

Neonatal Resuscitation: 2010 American Heart

Association Guidelines forCardiopulmonary Resuscitation and Emergency Cardiovascular Care

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Conclusion:
Australian birth forum most healthy babies do not require any suctioning and are quite capable of clearing their airways on their own

Oropharyngeal and meconium stained nasopharyngeal infants: study shows no suctioning of meconium- benefit from a routine stained neonates before suctioning delivery of their shoulders: multicentre, randomized controlled trial. Lancet 2004, Vain et al
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Conclusion:
Newborn Baby Care to Giving Birth Naturally, Beier, 2012 suctioning can only be performed when indicated rather than a routine procedure as most infants will be able to clear their own airways with no outside assistance

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Thank you

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