title: Oropharyngeal suctioning in neonates immediately after delivery: influence on cerebral and peripheral tissue oxygenation.
abstract: BACKGROUND
  Routine oropharyngeal suctioning in term vigorous neonates immediately after birth is a questionable practice. Current recommendations favor suctioning only in the presence of considerable obstruction due to secretions, blood or other matter. We aimed to analyze the influence of oropharyngeal suctioning on cerebral and peripheral muscle oxygenation in term neonates during transition immediately after birth.
  
  
  METHODS
  We included term neonates after elective cesarean section for this prospective observational study. Oropharyngeal suctioning was performed based on the clinicians' judgment of threatening airway obstruction. From a total of 138 enrolled neonates, 36 were suctioned and then compared to 36 controls matched for gestational age. Heart rate (HR) and pre/postductal arterial oxygen saturation (SpO2pre/SpO2post) were measured by pulse oximetry. Cerebral (rSO2brain) and pre/postductal peripheral muscle tissue oxygenation (rSO2pre/rSO2post) were measured by near infrared spectroscopy during the first 15min of life.
  
  
  RESULTS
  All neonates in both groups experienced normal postnatal transition with normal Apgar scores (Apgar 9/10/10) and with no events of apnea or bradycardia induced by suctioning. SpO2pre values were slightly lower at 2 and 4min after birth. Suctioning had no main and interaction effect on HR, SpO2post, rSO2brain, rSO2pre and rSO2post in the first 15min after birth.
  
  
  CONCLUSIONS
  In the present study we were able to show that, in term neonates, when correctly indicated, immediate postnatal oropharyngeal suctioning does not compromise cerebral and peripheral muscle tissue oxygenation. However, any suction maneuver must be performed with caution and strict indication during neonatal transition.
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria. Electronic address: mirjam.pocivalnik@medunigraz.at.
authors.forename: M
authors.initials: M
authors.lastname: Pocivalnik
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Urlesberger
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Ziehenberger
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Binder
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Schwaberger
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Canada; Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Alberta Health Services, Canada.
authors.forename: G M
authors.initials: GM
authors.lastname: Schmölzer
authors.affiliation: Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Avian
authors.affiliation: Research Unit for Cerebral Development and Oximetry Research, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria; Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Department of Pediatrics, Medical University of Graz, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Pichler
mesh_terms: D001921:Brain / Q000378:metabolism*; D016022:Case-Control Studies; D006801:Humans; D007231:Infant, Newborn; D007440:Intubation / Q000009:adverse effects*; D009132:Muscles / Q000378:metabolism*; D009960:Oropharynx; D010101:Oxygen Consumption; D013396:Suction / Q000009:adverse effects
keywords: Cerebral oxygenation; Elective cesarean section; Muscle oxygenation; Near-infrared spectroscopy; Oropharyngeal suctioning