298 - Impact of Change in Neonatal Resuscitation Program Guidelines for Infants Born Through Meconium-Stained Amniotic Fluid

Meconium-stained amniotic fluid (MSAF) can occur in up to 25% of all pregnancies, which often causes meconium aspiration syndrome (MAS), a potentially devastating outcome that can lead to surfactant inactivation, persistent pulmonary hypertension of the newborn (PPHN) or hypoxic respiratory failure (HRF) requiring mechanical ventilation in up to 50% of affected patients, and death in 5-12% (up to 40%) of affected patients. Prior to 2016, the neonatal resuscitation program (NRP) recommended intubating neonates to suction meconium below the level of the glottis in non-vigorous neonates. However, in its two most recent editions, the NRP withdrew that recommendation. Some studies associated this change in management with a higher incidence of adverse outcomes such as MAS, PPHN and need for mechanical ventilation. Other studies showed no difference in outcomes. In an ovine model of meconium aspiration, we showed that tracheal suctioning improves gas exchange but not hemodynamics. The approach to managing neonates born via MSAF remains to be a controversial issue with conflicting results.

Objective: To compare the differences in outcomes in non-vigorous neonates born through MSAF in our Regional Perinatal Center before and after the change in NRP’s recommendations.

Design/Methods:

This is a retrospective cohort study in a single-center 64 bedded level IV neonatal intensive care unit assessing all term and near-term neonates >/=34 weeks of gestation with MSAF in 2010-2015 (pre-implementation of new guidelines) and 2017-2022 (post-implementation of new guidelines) (Figure 1).

Results: There was no difference in the incidence of birth through MSAF between the two groups: 11.2% in 2010-2015 vs. 11.5% in 2017-2022; P=0.44. The incidence of being born non-vigorous was similar before and after implementation of the new guidelines (16.8% vs. 19.2%, respectively; P=0.10). Patients receiving tracheal suctioning were more likely to be diagnosed with MAS (29.3% vs. 19.7%; P=0.03) and PPHN (8.9% vs. 2.5%; P=0.003), and more likely to require surfactant in the delivery room (7.6% vs. 3.2%; P=0.03) (Tables 1 and 2).

Conclusion(s):

In our institution, non-vigorous neonates born through MSAF who received tracheal suctioning in the delivery room prior to change in NRP recommendations had a significantly higher incidence of MAS and PPHN, were more likely to require surfactant in the delivery room and were more likely to require mechanical ventilation. Our study supports the current NRP guidelines.