This document summarizes 2015 guidelines from the American Heart Association on resuscitation of babies born through meconium-stained amniotic fluid (MSAF). It finds that routine oropharyngeal and tracheal suctioning is not recommended for non-vigorous babies, as evidence shows it does not provide benefits and risks delaying other important resuscitation steps. For non-vigorous babies, the initial steps of resuscitation should be followed by positive pressure ventilation if needed. While an individual skilled in intubation should be present for babies with suspected fetal distress, routine intubation and suction is not suggested due to insufficient evidence of benefits and risk of harm. The guidelines emphasize early initiation of ventilation for non-

1. Resuscitation of Babies born through MSAF
2015 AHA Guidelines Update for CPR

2. • MSAF incidence-5% in PT,17% in term,27% in post
term.
• MAS 2-10% of babies born through MSAF
• Universal oropharyngeal suctioning on the perineum
followed by routine intubation and suctioning of the
trachea at birth was generally practiced .
• Practice abandoned vigorous babies born through
MSAF at birth did not benefit from intervention and
could avoid the risk of intubation

3. 2015 AHA Guidelines:
• Presence of MSAF -indicate fetal distress -infant may
require resuscitation ,individual skilled in tracheal
intubation should be present at the time of birth.
• Vigorous baby the infant stay with the mother initial
steps of newborn care-Gentle clearing of meconium from the
mouth and nose with a bulb syringe may be done if necessary.
• Non vigorous-Initial steps of resuscitation , PPV
initiated if the infant is not breathing or the heart
rate is less than 100/min after the initial steps are
completed.

4. • Routine intubation for tracheal suction in this
setting is not suggested, because there is
insufficient evidence .
• Greater value has been placed on harm
avoidance (ie, delays BMV,harm of the
procedure) over the unknown benefit of the
intervention of routine tracheal intubation and
suctioning.
• Emphasis should be made on initiating ventilation
within the first minute of life.

5. Chettri S, Adhisivam B, Bhat BV. Endotracheal suction for nonvigorous
neonates born through meconium stained amniotic fluid: a randomized
controlled trial. J Pediatr. 2015;166:1208–1213.
• Term, nonvigorous babies born through MSAF
were randomized to endotracheal suction and
no-suction groups (n=61 ).
• 39 (32%) neonates developed MAS and 18
(14.8%) of them died
• There were no significant differences in MAS,
its severity and complications, mortality, and
neurodevelopmental outcome for the 2
groups.

6. TOPIC NRP 2010 NRP 2015 ERC-2015 LOE COMMENTS
Clearing
the airway
when
meconium
is presesnt
Endotracheal
Suctioning in
non vigorous
baby.
1)Routine
intubation
and ET
suctioning not
indicated in
non vigorous
baby.
2)Initial steps
followed by
PPV should be
done as
routine
indiactions
Same as NRP-
2015.
Routine use of
surfactant not
indicated.
Class 2B -Major
change
having wide
implications.
-Emphasizes
on earlier
initiation of
PPV in non
vigorous
babies born
through
MSAF