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