![]() This quandary is not new because opportunities for intubation, particularly in the delivery room, have been declining for some time. 11 Furthermore, because work-hour limits have reduced the time spent by pediatric trainees in inpatient settings, there are fewer opportunities for procedural experience, including neonatal intubation. In an era of value-based care, we are performing fewer procedures and interventions as we move toward safely doing less in many areas of medicine. In this study, 10 an important additional question related to the potential decline of intubation experience in practitioners and trainees is also asked. They did not include potentially higher-risk late preterm infants in their cohort, nor did they limit their denominator to only those classified as nonvigorous at birth or to those admitted to the NICU. Their study stands apart in that they identified and included all deliveries attended for term infants born through MSAF at their institution. They did find a decrease in the need for respiratory support after the first day of life, improvement in 1-minute Apgar scores, and a decrease in the number of delivery room intubations. 10 They found no difference among the 2 groups in NICU admission rates, length of stay, and need for respiratory support on admission. In this study, the authors examined the clinical outcomes of term (≥37 weeks’ gestational age) infants born through MSAF at a single large academic center before and after adoption of the seventh edition NRP guidelines. In this issue of Hospital Pediatrics, Myers and Gupta 10 submit another entry into the literature to help us answer these questions. Nonetheless, the results of this study added to ongoing speculation regarding the latest changes in the NRP guidelines. It is unclear if perhaps some of the nonvigorous infants in the preintervention period remained so because of attempts to withhold stimulation to perform intubation before the first cry. In this cohort study, the authors looked specifically at nonvigorous infants born through MSAF and noted that the proportion of these infants declined from 10% to 8% after adoption of the recent NRP guidelines. However, no difference in the incidence of meconium aspiration syndrome (MAS) was observed. A retrospective study conducted by Chiruvolu et al 7 revealed an increase in NICU admissions for respiratory causes and an increase in the need for mechanical ventilation, oxygen therapy, and use of surfactant after implementation of the new guidelines. Aldhafeeri et al 6 conducted a retrospective single-center study, comparing outcomes before and after implementation of the most recent NRP guidelines, and found no significant difference in meconium aspiration related complications between the 2 groups. Meconium passage in a premature baby most often means the baby developed an infection while in the womb.However, do we do more harm by intubating or by not intubating these infants? In recent studies, others have attempted to shed light on this question. Depending on when they are born, preterm newborns have underdeveloped organs, which may not be ready to function outside of. read more, it is never normal for there to be meconium noted at the delivery of a premature baby Preterm (Premature) Newborns A preterm newborn is a baby delivered before 37 weeks of gestation. Near the end of a term pregnancy, the function of the placenta decreases, providing fewer nutrients and less oxygen to the. Although meconium passage may be normal in a term or postmature fetus Postterm Newborns A postterm newborn is a baby delivered after 42 weeks of gestation. But sometimes meconium passage occurs in response to stress, such as by an infection or by an inadequate level of oxygen in the blood. ![]() Passage of meconium may be normal before birth, particularly just before or after the due date. Meconium is usually passed after birth when newborns start to feed, but sometimes it is passed into the amniotic fluid before or around the time of birth. Meconium is the dark green, sterile fecal material that is produced in the intestine before birth.
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