ABSTRACT
OBJECTIVE: Disagreement exists concerning the appropriate delivery room management of the airway of vigorous meconium-stained infants. Some suggest a universal approach to intubation and suctioning of the airway in all such neonates, whereas others advocate a selective approach. We performed this investigation: 1) to assess whether intubation and suctioning of apparently vigorous, meconium-stained neonates would reduce the incidence of meconium aspiration syndrome (MAS); and 2) to determine the frequency of complications from delivery room intubation and suctioning of such infants. METHODS: Inclusion criteria included: 1) gestational age >/=37 weeks; 2) birth through meconium-stained amniotic fluid of any consistency; and 3) apparent vigor immediately after birth. Subjects were randomized to be intubated and suctioned (INT) or to expectant management (EXP). Primary outcome measures included: 1) the incidence of respiratory distress, including MAS, and 2) the incidence of complications from intubation. RESULTS: A total of 2094 neonates were enrolled from 12 participating centers (1051 INT and 1043 EXP). Meconium-stained amniotic fluid consistency was similar in both groups. Of the 149 (7.1%) infants that subsequently demonstrated respiratory distress, 62 (3.0%) had MAS and 87 (4.2%) had findings attributed to other disorders. There were no significant differences between groups in the occurrence of MAS (INT = 3.2%; EXP = 2.7%) or in the development of other respiratory disorders (INT = 3.8%; EXP = 4.5%). Of 1098 successfully intubated infants, 42 (3.8%) had a total of 51 complications of the procedure. In all cases, the complications were mild and transient in nature. CONCLUSIONS: Compared with expectant management, intubation and suctioning of the apparently vigorous meconium-stained infant does not result in a decreased incidence of MAS or other respiratory disorders. Complications of intubation are infrequent and short-lived.
Subject(s)
Infant, Newborn , Meconium Aspiration Syndrome/prevention & control , Meconium , Adult , Delivery Rooms , Female , Humans , Incidence , Intubation, Intratracheal/adverse effects , Male , Meconium Aspiration Syndrome/epidemiology , Pregnancy , Prospective Studies , Risk Factors , Suction/adverse effectsSubject(s)
Meningitis/diagnosis , Sepsis/diagnosis , Spinal Puncture , Humans , Infant, Newborn , Meningitis/blood , Research Design , Sepsis/bloodSubject(s)
Hypoglycemia/drug therapy , Somatostatin/analogs & derivatives , Blood Glucose/analysis , Humans , Hypoglycemia/blood , Hypoglycemia/etiology , Infant, Newborn , Insulin/blood , Male , Octreotide , Pancreatectomy , Pancreatic Diseases/complications , Pancreatic Diseases/surgery , Somatostatin/blood , Somatostatin/therapeutic useABSTRACT
A newborn female infant who experienced an intramural bladder hematoma with upper tract obstruction secondary to a suprapubic aspiration is described. The literature is reviewed and the conservative management of this child is discussed.
Subject(s)
Hematoma/etiology , Infant, Newborn, Diseases/etiology , Suction/adverse effects , Urinary Bladder Diseases/etiology , Female , Hematoma/therapy , Humans , Infant, Newborn , Infant, Newborn, Diseases/therapy , Urinary Bladder Diseases/therapyABSTRACT
Two cases of lactobezoar formation were seen in premature low-birth-weight infants in a 24 cal/oz formula fortified with medium-chain triglycerides and glucose polymers given by continuous nasogastric infusion. Medical management included cessation of oral feedings and increased hydration and led to a rapid dissolution of the problem. The use of this preparation in small low-birth-weight infants is not recommended as an initial formula, and it should only be used when oral feedings have been well tolerated in a growing premature infant.
