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EVALUATION STUDY
JOURNAL ARTICLE
Have the 2015 Neonatal Resuscitation Program Guidelines changed the management and outcome of infants born through meconium-stained amniotic fluid?
Annals of Saudi Medicine 2019 March
BACKGROUND: In 2015, the Neonatal Resuscitation Program (NRP) guidelines were updated to recommend that nonvigorous infants delivered through meconium-stained amniotic fluid (MSAF) do not require routine intubation and tracheal suction.
OBJECTIVE: Explore the implications of 2015 NRP guidelines on delivery room management and outcome of infants born through MSAF.
DESIGN: Retrospective cohort study.
SETTINGS: King Abdul-Aziz University Hospital (KAUH).
PATIENTS AND METHODS: All term ( greater than or equal 37 weeks) infants born in KAUH through MSAF between January 1, 2016, and December 31, 2017, were included. Patients were divided into two groups according to the date of birth: period 1 (January 1, 2016, to December 31, 2016), before the implementation of the new NRP guidelines; period 2 (January 1, 2017, to December 31, 2017), after the implementation.
MAIN OUTCOME MEASURES: Outcomes of infants born through MSAF.
SAMPLE SIZE: 420 infants.
RESULTS: A majority of infants (n=261) were born in period 1 and 159 after in period 2. No differences were found in the booking status of mothers, cesarean section rate, and number of deliveries attended by physicians between the 2 cohorts. Infants in both cohorts were of similar gestational age, birth weight, and gender. A nonsignificant lower rate of intubation at birth (2.3% vs 0.6%), admission to neonatal intensive care unit (3.8% vs 3.1%), and meconium aspiration syndrome (1.5% vs 0.6%) were found in period 2 compared with period 1. Only 1 infant died in period 1.
CONCLUSION: After the implementation of 2015 NRP guidelines, fewer infants were intubated at birth for MSAF. No difference was observed in the rate of associated morbidities and mortality.
LIMITATIONS: A single-center retrospective study of misclassification bias because some of the medical staff started practicing the new guidelines before the official implementation.
CONFLICT OF INTEREST: None.
OBJECTIVE: Explore the implications of 2015 NRP guidelines on delivery room management and outcome of infants born through MSAF.
DESIGN: Retrospective cohort study.
SETTINGS: King Abdul-Aziz University Hospital (KAUH).
PATIENTS AND METHODS: All term ( greater than or equal 37 weeks) infants born in KAUH through MSAF between January 1, 2016, and December 31, 2017, were included. Patients were divided into two groups according to the date of birth: period 1 (January 1, 2016, to December 31, 2016), before the implementation of the new NRP guidelines; period 2 (January 1, 2017, to December 31, 2017), after the implementation.
MAIN OUTCOME MEASURES: Outcomes of infants born through MSAF.
SAMPLE SIZE: 420 infants.
RESULTS: A majority of infants (n=261) were born in period 1 and 159 after in period 2. No differences were found in the booking status of mothers, cesarean section rate, and number of deliveries attended by physicians between the 2 cohorts. Infants in both cohorts were of similar gestational age, birth weight, and gender. A nonsignificant lower rate of intubation at birth (2.3% vs 0.6%), admission to neonatal intensive care unit (3.8% vs 3.1%), and meconium aspiration syndrome (1.5% vs 0.6%) were found in period 2 compared with period 1. Only 1 infant died in period 1.
CONCLUSION: After the implementation of 2015 NRP guidelines, fewer infants were intubated at birth for MSAF. No difference was observed in the rate of associated morbidities and mortality.
LIMITATIONS: A single-center retrospective study of misclassification bias because some of the medical staff started practicing the new guidelines before the official implementation.
CONFLICT OF INTEREST: None.
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