Endotracheal intubation at birth in vigorous term meconium stained babies
RHL practical aspects by Ramji S
FIRST CONTACT (PRIMARY CARE) LEVEL
At small health facilities where midwives or general practitioners generally conduct deliveries, all infants born with exposure to meconium stained liquor (MSL) should have their oropharynx suctioned at the delivery of head with a simple mucus extractor. After birth, if the infant is vigorous, he/she should only be observed for any signs and symptoms of aspiration.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Most referral hospitals in developing countries are staffed with a specialist in paediatrics, obstetrics and anaesthesia. Unfortunately, most of them are not formally certified in neonatal advanced life support and are often poorly skilled at intubating newborns. All such facilities must ensure that their specialist staff are skilled in neonatal resuscitation, especially intubation.
Hospitals must provide opportunities for on-job continuous skill training by establishing resuscitation practice corners that are equipped with training manikins. Based on present evidence, indication for intubation should be based on other criteria and not on presence or absence of meconium alone. Clear written protocols on selection of infants for intubation would be helpful. This would result in better management of babies at risk for asphyxia and better utilization of available resources.
AT HOME OR IN THE COMMUNITY
Most births occurring at home are attended by untrained birth attendants. No intervention is really possible at this level for babies born with exposure to MSL.
This document should be cited as: Ramji S. Endotracheal intubation at birth in vigorous term meconium stained babies: RHL practical aspects (last revised: 16 January 2002). The WHO Reproductive Health Library; Geneva: World Health Organization.