Prevention and management of meconium aspiration syndrome—assessment of evidence based practice

Excerpt

Sir: We thank Dr. Vain and colleagues for their commendation of our comparison of current practice for prevention and management of meconium aspiration syndrome [1]. They comment we should have more widely discussed suctioning of the hypopharynx before the delivery of the shoulders. They will note, however, our assessment was published as a short report and the number of references we were able to quote was restricted, hence we used peer-reviewed papers and Cochrane reviews. We did point out that, in the Cochrane review referenced below [2], the meta analysis of four randomised trials had demonstrated no significant benefit of routine endotracheal incubation and suctioning over routine resuscitation. As correctly concluded by Dr. Vain, their paper had not been published when our survey of UK neonatal units was conducted. We thank them for highlighting their results from a multicentre randomised controlled trial showing suctioning of meconium stained infants before the delivery of the shoulders makes no difference to the incidence, severity or mortality of meconium aspiration syndrome [3]. It is not, however, our experience that in the UK, such a procedure is undertaken routinely and as stated it is not a recommendation of the British Council for Neonatal Resuscitation. …