Airway Clearance of the Term Newborn.

PURPOSE: This descriptive, observational study explored the practice of airway clearance of the term newborn at birth. The American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council have established guidelines for suctioning the well newborn. STUDY DESIGN AND METHODS: Airway clearance practices of nurses, obstetricians, and respiratory therapists at 10 cesarean births and 10 vaginal births were observed. Data were analyzed using descriptive statistics and through content analysis of narratives. RESULTS: All newborns observed experienced at least one airway clearance event and multiple airway clearance passes. Indications for suctioning were not consistent with professional guidelines. Airway clearance procedures and practices were inconsistent. Two suction devices used: the blue bulb syringe and orogastric catheter. If a newborn was suctioned three times, the orogastric catheter was the predominate device used. CLINICAL IMPLICATIONS: There was a lack of adherence to established clinical guidelines for newborn airway clearance. Further study is needed to identify education of airway clearance guidelines. Specific protocols such as safe suctioning methods, correct device use, and observation of complications associated with airway management need to be developed to support a newborn's healthy transition at birth.

Airway Clearance of the Term Newborn.

PURPOSE: The purpose of this study was to explore airway clearance practices for the preterm newborn in the neonatal intensive care unit (NICU). STUDY DESIGN AND METHODS: This descriptive, retrospective medical record review analyzed airway clearance practices in a level III regional NICU from 2016 to 2017 in preterm newborns ranging from 32 weeks to 36 weeks and 6 days. There were 87 preterm newborns and 384 suctioning events reviewed during the entire length of stay. Practices reviewed include device used, frequency, color, consistency, and tolerance of airway clearance. Method of nursing documentation for these practices was also reviewed. RESULTS: Babies born via cesarean required more suctioning (65.5%). Males (60.9%) required more airway clearance events than females (39.1%). After suction events, nurses reported no distress (74%), equal bilateral breath sounds (30%), desaturation (6%), and collectively color change, apnea, or bradycardia (<1%). The most common discharge diagnosis was respiratory distress syndrome (90%). Preterm newborns were suctioned with the blue bulb syringe (15.6%), oral/nasal-pharyngeal suction device (42.7%), and endotracheal suction devices (41.7%). CLINICAL IMPLICATIONS: Electronic medical records promote less detailed, narrative documentation and more point and click documentation. If electronic medical record systems are not designed to gather airway clearance indications, specifics about the procedure and the preterm newborn response to the procedure, evidence-based practice cannot be measured. More studies are needed to evaluate suction practices applied in the NICU setting.