{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:05:07Z","timestamp":1791813907127,"version":"4.3.4"},"reference-count":41,"publisher":"Georg Thieme Verlag KG","issue":"09","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2024,7]]},"abstract":"<jats:p>\n            Objective\u2003The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation.<\/jats:p><jats:p>\n            Study Design\u2003This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n\u2009=\u2009276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n\u2009=\u2009271).<\/jats:p><jats:p>\n            Results\u2003Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p\u2009=\u20090.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p\u2009=\u20090.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p\u2009=\u20090.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p\u2009=\u20090.04) were significantly lesser.<\/jats:p><jats:p>\n            Conclusion\u2003Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/a-1797-7005","type":"journal-article","created":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:08:55Z","timestamp":1647302935000},"page":"1163-1170","source":"Crossref","is-referenced-by-count":9,"title":["Outcomes of Nonvigorous Neonates Born through Meconium-Stained Amniotic Fluid after a Practice Change to No Routine Endotracheal Suctioning from a Developing Country"],"prefix":"10.1055","volume":"41","author":[{"given":"Gunjana","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srishti","family":"Goel","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushma","family":"Nangia","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viraraghavan Vadakkencherry","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Ankura Hospital for Women and Children, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,6,7]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/0002-9378(93)90132-3","article-title":"Prediction of the severity of meconium aspiration syndrome","volume":"169","author":"C Hern\u00e1ndez","year":"1993","journal-title":"Am J Obstet Gynecol"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1016\/j.pcl.2004.01.012","article-title":"Meconium stained fluid: approach to the mother and the baby","volume":"51","author":"S L Gelfand","year":"2004","journal-title":"Pediatr Clin North Am"},{"key":"ref3","first-page":"705","volume-title":"Respiratory failure in the term infant","author":"R A Ballard","year":"2005"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/S0377-1237(10)80131-5","article-title":"Meconium aspiration syndrome: an insight","volume":"66","author":"U Raju","year":"2010","journal-title":"Med J Armed Forces India"},{"issue":"11","key":"ref5","doi-asserted-by":"crossref","first-page":"e0242025","DOI":"10.1371\/journal.pone.0242025","article-title":"Perinatal outcome of meconium stained amniotic fluid among labouring mothers at teaching referral hospital in urban Ethiopia","volume":"15","author":"L B Tolu","year":"2020","journal-title":"PLoS One"},{"issue":"03","key":"ref6","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1002\/ijgo.13592","article-title":"Prediction of adverse neonatal outcome among newborns born through meconium-stained amniotic fluid","volume":"154","author":"G Levin","year":"2021","journal-title":"Int J Gynaecol Obstet"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1038\/sj.jp.7210564","article-title":"Meconium-stained amniotic fluid and neonatal morbidity in near-term and term deliveries with acute histologic chorioamnionitis and\/or funisitis","volume":"21","author":"S Rao","year":"2001","journal-title":"J Perinatol"},{"issue":"03","key":"ref8","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1067\/mpd.2002.122730","article-title":"Neurodevelopmental and medical outcomes of persistent pulmonary hypertension in term newborns treated with nitric oxide","volume":"140","author":"P H Lipkin","year":"2002","journal-title":"J Pediatr"},{"issue":"09","key":"ref9","first-page":"711","article-title":"Neonatal outcome in meconium stained amniotic fluid-one year experience","volume":"60","author":"E M Shaikh","year":"2010","journal-title":"J Pak Med Assoc"},{"issue":"09","key":"ref10","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1055\/s-0037-1620269","article-title":"Approach to infants born through meconium stained amniotic fluid: evolution based on evidence?","volume":"35","author":"M Rawat","year":"2018","journal-title":"Am J Perinatol"},{"issue":"04","key":"ref11","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1016\/j.clp.2012.09.004","article-title":"Delivery room management of meconium-stained infant","volume":"39","author":"R Bhat","year":"2012","journal-title":"Clin Perinatol"},{"key":"ref12","first-page":"293","article-title":"2005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. 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