title: Oronasopharyngeal suction versus wiping of the mouth and nose at birth: a randomised equivalency trial.
abstract: BACKGROUND
  Wiping of the mouth and nose at birth is an alternative method to oronasopharyngeal suction in delivery-room management of neonates, but whether these methods have equivalent effectiveness is unclear.
  
  
  METHODS
  For this randomised equivalency trial, neonates delivered at 35 weeks' gestation or later at the University of Alabama at Birmingham Hospital, Birmingham, AL, USA, between October, 2010, and November, 2011, were eligible. Before birth, neonates were randomly assigned gentle wiping of the face, mouth (implemented by the paediatric or obstetric resident), and nose with a towel (wipe group) or suction with a bulb syringe of the mouth and nostrils (suction group). The primary outcome was the respiratory rate in the first 24 h after birth. We hypothesised that respiratory rates would differ by fewer than 4 breaths per min between groups. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01197807.
  
  
  RESULTS
  506 neonates born at a median of 39 weeks' gestation (IQR 38-40) were randomised. Three parents withdrew consent and 15 non-vigorous neonates with meconium-stained amniotic fluid were excluded. Among the 488 treated neonates, the mean respiratory rates in the first 24 h were 51 (SD 8) breaths per min in the wipe group and 50 (6) breaths per min in the suction group (difference of means 1 breath per min, 95% CI -2 to 0, p<0·001).
  
  
  CONCLUSIONS
  Wiping the nose and mouth has equivalent efficacy to routine use of oronasopharyngeal suction in neonates born at or beyond 35 weeks' gestation.
  
  
  BACKGROUND
  None.
authors.affiliation: Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: John
authors.initials: J
authors.lastname: Kelleher
authors.forename: Ramachandra
authors.initials: R
authors.lastname: Bhat
authors.forename: Ariel A
authors.initials: AA
authors.lastname: Salas
authors.forename: Dylan
authors.initials: D
authors.lastname: Addis
authors.forename: Emily C
authors.initials: EC
authors.lastname: Mills
authors.forename: Himel
authors.initials: H
authors.lastname: Mallick
authors.forename: Arvind
authors.initials: A
authors.lastname: Tripathi
authors.forename: Elizabeth P
authors.initials: EP
authors.lastname: Pruitt
authors.forename: Claire
authors.initials: C
authors.lastname: Roane
authors.forename: Tara
authors.initials: T
authors.lastname: McNair
authors.forename: John
authors.initials: J
authors.lastname: Owen
authors.forename: Namasivayam
authors.initials: N
authors.lastname: Ambalavanan
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009055:Mouth; D009666:Nose; D009910:Oral Hygiene / Q000379:methods; D018743:Perinatal Care / Q000379:methods*; D056152:Respiratory Rate / Q000502:physiology*; D013396:Suction / Q000379:methods*; D016896:Treatment Outcome