New recommendations from the AAP to not intubate infants born with MAS

Meconium aspiration syndrome (MAS) occurs when a baby passes meconium into the amniotic fluid, and then inhales into the lungs. This aspiration can happen: 

 

  • - In utero 

  • - During delivery  

  • - Immediately after birth  

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According to Medline Plus, early meconium release can occur when a baby is under stress due to a decrease in blood or oxygen supply. Risk factors can include prolonged labor, high blood pressure or diabetes in the mother among others (MedlinePlus). 

 

There has been debate among pediatric groups about the need to intubate and suction a nonvigorous infant where meconium stained amniotic fluid (MSAF) is present. "Nonvigorous" refers to: "presence of any of the following at the time of birth: no or gasping breathing efforts, poor muscle tone or bradycardia" (Wyckoff 2015). The American Heart Association along with the American Academy of Pediatrics removed the recommendation to intubate in 2015, and there have been mixed reviews on the outcome for the nonvigorous infants who were not intubated.  

 

Researchers Myers and Gupta looked into the effect of no longer intubating nonvigorous infants born with MSAF. Using data from a 3 year span with over 14,000 infants who matched the criteria, they saw that intubation rates fell dramatically once the new AAP recommendations were in place. With decreased intubation, the researchers found that “1-minute Apgar scores were significantly more likely to be >3 (P = .009) and significantly less likely to be <7 (P = .011). The need for continued respiratory support after the first day of life also decreased” (Myers and Gupta, 2020).

  

Overall they found that decreased intubation was positive, with no changes in NICU admittance or duration. A caveat is that care providers are no longer getting the experience needed for an intubation, and may need to provide simulations to allow for ongoing practice of this skill. 

 

If your child was diagnosed with meconium aspiration syndrome that you believe was caused by medical negligence, you may be eligible for compensation. Holton Law Firm's experienced birth injury lawyers can help you explore your legal options. Call our Memphis law office today to schedule a free initial case consultation. 

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