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You are assisting the pediatric team during a routine delivery of a full-term<br />
newborn. The obstetrician notes thick meconium on delivery of the infant, who is<br />
not crying and looks floppy in the obstetrician’s hands. Your recommendation for<br />
FIRST course of action is:<br />
<br />
a) Intrapartum suctioning of the oropharynx by the obstetrician<br />
<br />
b) Stimulation of the infant with drying and warming<br />
<br />
c) Intubation of the trachea with suctioning<br />
<br />
d) Positive pressure ventilation with 100% oxygen<br />
<br />
e) Suctioning of the oropharynx by the pediatric team at the infant warmer<br />
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==Answer==<br />
Answer c. This is a non-vigorous infant with thick meconium. Intubation with<br />
suctioning is the preferred first step. Stimulation via suctioning or drying the<br />
infant may lead to a gasping respiration and increased aspiration of meconium<br />
from the trachea/upper airway into the lungs. Importantly, if endotracheal<br />
intubation is not able to be rapidly performed, the infant should be ventilated<br />
with PPV via bag-mask device before bradycardia ensues.<br />
==Notes==<br />
<references /><br />
:This question originally printed in the [http://www.amazon.com/Justin-L.-Lockman/e/B00FLG5AEE/ref=ntt_dp_epwbk_0 Pediatric Anesthesiology Review Topics] kindle book series, and appears courtesy of Naerthwyn Press, LLC.<br />
==Keywords==<br />
:<br />
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