Friday, February 24, 2017

ACOG updates its guidelines on management of newborn with meconium-stained amniotic fluid.

Newborn resuscitation 

The American College of Obstetricians and Gynecologists (ACOG) updates its guidelines regarding resuscitation of newborn with meconium stained liquor.  The guidelines were published in the forthcoming March issue of Obstetrics and Gynecology. [1]

The committee opinion says that:

  • The resuscitation of infants with meconium stained liquor should follow the same principles as a newborn with clear fluids.
  • ACOG also advises against intrapartum suctioning irrespective of the fact that the newborn is vigorous or lethargic. At the same time, it mandates that a trained team of pediatrician or other medical personnel who are well versed with full resuscitation including endotracheal intubation should be present at the time of delivery.

The new recommendation against intrapartum suctioning whether a newborn is lethargic or vigorous is based on prevention of harm (the unnecessary delay providing bag-mask ventilation) because of precious time lost in suction.

The American Academy of Pediatrics and the American Heart Association first published the guidelines in 2006. Before the guidelines were formulated, delivery of all meconium stained newborn was managed by suction of the oropharynx and nasopharynx at the perineum before the delivery of the shoulders (intrapartum suctioning).

The guidelines did not support the practice of routine suction as it did not alter the incidence of meconium aspiration syndrome in vigorous infants. Non-vigorous newborns did undergo active incubation of trachea and suctioning of meconium and other aspirated from below the glottis.

The guidelines regarding management of lethargic and non-vigorous were again updated in 2015 which advised that if a non-vigorous infant has got good muscle tone, then the infant can be roomed in with mother after gentle cleaning of mouth and nose with a bulb syringe.[2]

If the infant lack muscle tone and breathing efforts he should be immediately shifted under a radiant muscle warmer and appropriate decisions should be individualized according to clinical condition. PPV should be initiated if the infant is not breathing or the heart rate is less than 100/min after the initial steps are completed. Routine intubation and suction is not recommended in all non-vigorous infants with meconium stained amniotic fluid.

If the airway is plugged by meconium, intubation and cleaning should be done.
ACOG practice committee updated its recommendation regarding timing of cord-clamping on December 22, 2016.
The article can be accessed here



  1. Thanks. Any new / modified recommendations about"Delayed c;amping of cord " vis a vis "Early cord clamping"?

    1. Please read the earlier blog post. Here is the link: