{"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":1791813907192,"version":"4.3.4"},"reference-count":10,"publisher":"SAGE Publications","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NPM"],"published-print":{"date-parts":[[2023,10,11]]},"abstract":"<jats:p>BACKGROUND: Suctioning of the posterior pharynx immediately after birth during neonatal resuscitation can produce a vagal response resulting in bradycardia or apnea. The feasibility of delaying any airway suctioning and avoiding deep suctioning has not been studied. OBJECTIVES: To test the hypothesis that newborn resuscitation is feasible with the following two guidelines: 1) avoiding any suctioning until the infant establishes spontaneous respiration, and 2) avoiding the use of deep suction with catheters. STUDY DESIGN: A quality improvement project was implemented using these two guidelines. Infants\u2019 mouth was cleaned with a dry cloth. No suction was started until infants establish spontaneous breathing. Then, bulb suction was used to clear secretions from the sides of the mouth and the nose without reaching the back of the pharynx. Deep suction using catheters was not used. Neonatal staff and physicians received biweekly training to support these changes. Resuscitation data before and after the practice change were compared. RESULTS: A total of 999 sequential cases were compared; of them 501 and 498 infants were resuscitated before and after the implementation of the new practice, respectively. Suction before spontaneous breathing occurred in 12.4% in the first cohort. There were no differences between groups except for less use of oxygen with the new guidelines (12.4% vs 4.4%, P\u200a&lt;\u200a0.001). CONCLUSION: Avoidance of any suction prior to spontaneous breathing and not applying deep suction with catheters are feasible during newborn resuscitation. These practices are associated with decreased exposure to oxygen in the delivery room.<\/jats:p>","DOI":"10.3233\/npm-230080","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T13:44:39Z","timestamp":1695735879000},"page":"387-391","source":"Crossref","is-referenced-by-count":6,"title":["Is it feasible to avoid suction before spontaneous breathing is established?"],"prefix":"10.1177","volume":"16","author":[{"given":"T.H.","family":"Nesterenko","sequence":"first","affiliation":[{"name":"Department of Neonatology, Cleveland Clinic Children\u2019s Hospital, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Pocevic","sequence":"additional","affiliation":[{"name":"Department of Neonatology, The George Washington University Hospital and Children\u2019s National Medical Center, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Elgendy","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Cleveland Clinic Children\u2019s Hospital, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.A.","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Cleveland Clinic Children\u2019s Hospital, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Aly","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Cleveland Clinic Children\u2019s Hospital, Cleveland, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"key":"10.3233\/NPM-230080_ref1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1159\/000087604","article-title":"Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: A 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term vaginally born infants","volume":"20","author":"Estol","year":"1992","journal-title":"J Perinat Med"},{"key":"10.3233\/NPM-230080_ref5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/peds.105.1.1","article-title":"Delivery room management of the apparently vigorous meconium-stained neonate: Results of the multicenter, international collaborative trial","volume":"105","author":"Wiswell","year":"2000","journal-title":"Pediatrics"},{"key":"10.3233\/NPM-230080_ref6","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S0140-6736(04)16852-9","article-title":"Oropharyngeal and nasopharyngeal suctioning of meconium-stained neonates before delivery of their shoulders: multicenter, randomized controlled trial","volume":"364","author":"Vain","year":"2004","journal-title":"Lancet"},{"key":"10.3233\/NPM-230080_ref7","first-page":"140","article-title":"Does medical evidence support routine oronasopharyngeal suction at delivery?","volume":"109","author":"Evans","year":"2016","journal-title":"J Okla State Med Assoc"},{"key":"10.3233\/NPM-230080_ref8","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/S0140-6736(13)60775-8","article-title":"Oronasopharyngeal suction versus wiping of the mouth and nose at birth: A randomized equivalency trial","volume":"382","author":"Kelleher","year":"2013","journal-title":"Lancet"},{"key":"10.3233\/NPM-230080_ref9","unstructured":"Textbook of neonatal resuscitation. 7th edition, 2016.Elk GroveVillage, IL, American Academy of Pediatrics (AAP)."},{"key":"10.3233\/NPM-230080_ref10","first-page":"CD010332","article-title":"Routine oro\/nasopharyngeal suction versus no suction at birth","volume":"4","author":"Foster","year":"2017","journal-title":"Cochrane Database Syst Rev"}],"container-title":["Journal of Neonatal-Perinatal 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